Hand Sculptured Light

Hand Sculptured Light

Hand prosthesis: An art of reconstruction

 

Introduction:

"It is the God given right of every human being to appear human".

Any kind of deformity, facial or elsewhere may cause psychological and emotional disturbance to the patient as well as social annihilation. Both function and form are important attributes of the hand. The active function of the hand is represented by its prehensile activities in grip, grasp, transferring and absorbing forces.1

         Nowadays the amputation of one or more fingers of the hand, as the consequence of trauma or congenital absence of one or more phalanxes, carries a serious reduction of hand function and social dysfunction for the patient.2 Currently, many injuries and traumatic amputations of fingers can be rescued by microsurgery through reimplantation. However, in some cases, reconstruction is either not advisable or partially successful.3 It is in this group of patients that prosthesis can be provided and may offer great psychological help.4

         Esthetic prostheses for the hand can offer psychological, functional and rehabilitative advantages. By restoring the natural appearance to the hand, prosthesis eliminates the trauma caused by constant reminder of the handicap and, thus offers true psychological therapy.5 Thus, the purpose of this report is to describe a simple technique for fabrication of acrylic resin hand prosthesis for a patient after an accident at work to provide motor skills recovery and diminished social discrimination.

Case report:

A patient was attended in the clinic for rehabilitation of the left hand with missing middle finger, ring finger and little finger including the respective metacarpal bones (fig 1,2).

 

When multiple fingers are missing, extensive skin coverage must be considered. It was preferred to fabricate partial hand prosthesis for multiple finger loss, with the uninjured fingers left free, because they can apply more force and use the hand for a variety of activities. Upon examination, the remaining stump was found to be stable and rehabilitative process was possible using conventional hand prosthesis.

 

Technique:

An impression of the remaining stump was made using the irreversible hydrocolloid material (Neocolloid; Zhermack: Kab dental supplies) (fig 3).

         To maintain a natural appearance, the prosthesis was sculpted with each joint slightly flexed. Wax pattern was hollowed from inside to make the final prosthesis light in weight. Later it was placed in warm water so that the fingers were shaped to mimic the natural opposing hand when it is held at rest. Borders were merged with the skin adjacent to the defect site (fig 4).

         For retention of the prosthesis, two loops made of orthodontic wire were embedded into the hollow part of the wax pattern. These loops were used to engage the Velcro strap. Additional retention was achieved through a finger ring which engaged the index finger.

         The wax pattern was then tried on the patient. The fit, stability, borders and retention of the pattern were evaluated along with shape and size of the pattern. The anatomic lines were then checked to improve esthetics. Using lost wax technique a three piece mould using type III dental stone was made to fabricate the prosthesis (fig 5).

Heat polymerizing clear acrylic resin (DPI – Heat cure; Dental products of India ltd) was intrinsically pigmented according to the skin color of the patient. Color matching of the under surface was done first as this tends to be lighter than the top surface. For finger nails, acrylic resin was pigmented to mach the patient's natural nails. Both the halves of the flask were closed; light pressure was applied to remove excess flash. The resin was processed at slow curing cycle of polymerization. When the moulds were sufficiently cool, the prosthesis was carefully removed. The fit and shade was evaluated on the patient. Extrinsic coloring was done to match the exact color of the patient and have life-like appearance. Careful coloration is crucial for maximal patient acceptance. The patient was wearing the prosthesis under a variety of light sources (fig 6, 7). To achieve an enhanced realistic appearance, the nail and nail bed were shaped with trimmer according to the nails of the natural fingers. The prosthesis was inserted and the patient was instructed in home care and prosthesis maintenance.

Discussion:

Finger reconstruction, especially of proximal phalanx, requires complex surgical procedures with specific functional and cosmetic requirements. Furthermore, even when these techniques offer several advantages whenever fingers are amputated or mutilated, it is very limited in amputation of the proximal phalanxes of the second and third finger because the transposed digital finger may reveal itself too short and consequently not functional at all.

         Our patient was not willing for any reconstructive surgical correction. Considering the age, general health and economic status of the patient, we were oriented towards the non invasive technique which would solve the aesthetic need of the patient. For these reasons, prosthetic rehabilitation was introduced and a number of materials and technique have been developed to be used in this process. The acrylic resin and silicone are the most common materials used for rehabilitation. Although silicone has texture and flexibility similar to the skin, provides a more comfortable and better capacity for skin – prosthesis linkage. However, this material is more difficult to pigment and degrades due to color instability when exposed to ultraviolet rays.6

         On the other hand, even though acrylic resin is a very hard material and slightly uncomfortable to the patient, but there are added advantages such as easily characterized, presents great durability, cost effective, relined or repaired easily and intrinsic and extrinsic color matching is best achieved.

         Among the sculpture techniques there is the analogous finger technique, which is performed by moulding and sculpture of another person finger or can also be carried out based on anatomical reproduction.7,8

         Currently, the methods for prosthesis retention to the remaining part of the finger include ring, double ring, adhesives and osseointegrated implants.4,9Although the patients frequently require optimal reconstruction of the hand in cases of injury or amputation, prosthetic devices recover only basic functions of the hand. Minute finger control requires considerable mechanical engineering that encompasses an efficient motor drive and adequate power supply which renders possible prototypes for hand prostheses in everyday performance.10

         Bone anchoring is another alternative method used since 25 years in oral surgery; it was first described by Branemark11,12 as an alternative technique to dental prosthesis. For many years it was treatment of choice for teethless patients until Lundborg13 in 1993, started the use of osseointegrated implants to anchor prosthesis of long bones of the leg. Later this technique was applied to retain the maxillofacial prostheses. The limitations of this procedure are, it requires preservation and normal functioning of the metacarpal phalanx joint and the presence of an adequate consistency of the bone to allow implants anchoring. The major complications are: lack of osseous integration of the implant, but is very rare, detachment of the prosthesis or lack of acceptance by the patient.4,14

CONCLUSION:

Good suspension alone is not sufficient for patient   acceptance   of hand prosthesis. For many patients, a high level of cosmesis is paramount. Characteristics such as a pleasing shape, thin margins, lifelike finger nails, realistic color, contours, and detail are essential for patient satisfaction. This level of restoration is most successful when hand prostheses are individually sculpted and colored in situ under variety of lighting conditions.

 

References:

1. Pereira BP, kour AL, Leow EL, Pho RWH. Benefits and use of digital prostheses. J Hand Surg (Am) 1996; 21: 222-28.
2. Cervelli V, Bottini DJ, Arpino A, Grimaldi M, Rogliani M, Gentile P. Bone anchored implant in cosmetic finger reconstruction.Annales de chirurgie plastique esthetique 2008; 53: 365 – 67.
3. Wilson RL, Carter- Wilson MS. Rehabilitation after amputations in the hand. Orthop clin north Am 1983; 14: 851- 72
4. Pilley MJ, Quinton DN. Digital prostheses for single finger amputation. J Hand Surg (Br) 1999; 24(5): 539-41
5. Pillet J. Esthetic hand prosthesis. J Hand Surg (Am) 1983; 8: 778 – 781
6. Gary JJ, Huget EF, Powell LD. Accelerated colour change in a maxillofacial elastomer with and without pigmentation. J Prosthet Dent 2001; 85: 614 – 20
7. Alison A, Mackinnon SE. Evaluation of digital prostheses. J Hand Surg (Am) 1992; 17: 923 – 26
8. O'Farrell DA, Montella BJ, Bahor JL, Levin LS. Long term follow-up of 50 duke silicone prosthetic fingers.  J Hand Surg (Br) 1996; 21: 696-700
9. Yazdanie N. Prosthetic rehabilitation of an amputated thumb. J Coll Physicians Surg Pak 2003; 13: 355 – 6
10. Matussek J, Neff G. The artificial hand - An overview of hand prostheses. Orthopedics 2003; 32: 406- 12.
11. Tjellstorm A, Rosenhall U, Lind Storm J, HAllen O, Albrektsson T, Branemark PI. Five year experience with skin penetrating bone-anchored implants in the temporal bone. Acta Otolaryngol 1983; 95(5-6): 568 – 75.
12. Eriksson E, Branemark PI. Osseointegration from the perspective of the plastic surgeon. Plast Reconstr Surg 1994; 93(3): 626 – 37
13. Manurangsee P, Isariyawnt C, CAtuthong V, Mekraksawanit S. Osseointegrated finger prosthesis: An alternative method for finger reconstruction. J Hand Surg(Am) 2000; 25(1): 86 – 92.
14. Lundborg G, Branemark PI, Rosen B. Osseointegrated thumb prostheses: A concept for fixation of digit prosthetic devices. J Hand Surg(Am) 1996; 21(2): 216 – 21.

About the Author

1. Dr Nivedita  Mankani

 MDS, senior lecturer, department of prosthodontics, PMNM dental college and hospital, Bagalkot 587101, karnataka, India

Phone no - +919481212040

E-mail id – drniveditam@yahoo.co.in

  2. Dr Nagaraj. E 

 MDS,  senior lecturer, department of prosthodontics, PMNM dental college and hospital, Bagalkot 587101, karnataka, India

Phone no - +919916809032

E-mail id – dr_nagaraj_e@yahoo.co.in

3. Dr  Brijesh A. Patil

MS (Ophthalmology), Associate Professor, S.Nigalingappa Medical college and hospital, Bagalkot, Karnataka,India

Phone number: +919481212020

Email id : drbrij74@yahoo.co.in

4. Dr Gangadhar B.Angadi

BDS, Lecturer, department of periodontics, PMNM dental college and hospital, Bagalkot 587101, karnataka, India.

DISTURBING CUSTOM SKULL & DEMON THEMED MOTORCYCLE BY AWARD WINNING BLUE FLAME ALLEY STUDIOS.. TWISTED HAND SCULPTED 3D FIBERGLASS! DEMONIC GIGER STYLE ARTWORK THAT WILL BLOW YOUR MIND. EVER SEEN AIRBRUSH LIKE THIS??

Handcrafted Mahogany Wood 'Toucan Secrets' Puzzle Box (Guatemala) $43.99 A toucan from Guatemala's verdant rainforest becomes a puzzle box in richly grained mahogany wood featuring two secret compartments. Francisco Mendoza hand-carves the puzzle box of mahogany wood, dark granadillo and light guachipilin woods.

Nativity Around a Tea Light $19.49 Tea light holder by Next Season Design will add a stylish touch to your holiday decorDecorative collectible is made of heavy and genuine materialsAttractive sculpture is handmade and hand-painted

Santas Around a Tea Light $19.49 Tea light holder by Next Season Design adds a stylish touch to your holiday decorDecorative collectible made of heavy and genuine materialsAttractive sculpture is handmade and hand-painted with much detail

OMH Wooden Runabout Scale Model $99.99 Completely hand-built, the runabout is characterized by the all-wood construction of its hull and its inboard motor. On this model, you can locate the beautiful crafted wooden and metal features such as steering wheel, lights, propeller, and more.

Yellow Lab Sculptured Portrait $38.95 You will love the fine detail and clever way this Yellow Lab Portrait captures all the best features and spirit of your favorite friend. Our Yellow Lab Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Yellow Lab Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Yorkshire Terrier Sculptured Portrait $38.95 You will love the fine detail and clever way this Yorkshire Terrier Portrait captures all the best features and spirit of your favorite friend. Our Yorkshire Terrier Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Yorkshire Terrier Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Rottweiler Sculptured Portrait $38.95 You will love the fine detail and clever way this DRottweiler Portrait captures all the best features and spirit of your favorite friend. Our Rottweiler Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Rottweiler Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Siberian Husky Sculptured Portrait $38.95 You will love the fine detail and clever way this Siberian Husky Portrait captures all the best features and spirit of your favorite friend. Our Siberian Husky Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Siberian Husky Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Cocker Spaniel Sculptured Portrait $38.95 You will love the fine detail and clever way this Cocker Spaniel Portrait captures all the best features and spirit of your favorite friend. Our Cocker Spaniel Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Cocker Spaniel Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Dachshund Sculptured Portrait $38.95 You will love the fine detail and clever way this Dachshund Portrait captures all the best features and spirit of your favorite friend. Our Dachshund Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Dachshund Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Dachshund Sculptured Portrait Black $38.95 You will love the fine detail and clever way this Dachshund Portrait captures all the best features and spirit of your favorite friend. Our Dachshund Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Dachshund Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Dalmatian Sculptured Portrait $38.95 You will love the fine detail and clever way this Dalmation Portrait captures all the best features and spirit of your favorite friend. Our Dalmation Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Dalmation Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Chihuahua Sculptured Portrait $38.95 You will love the fine detail and clever way this Chihuahua Portrait captures all the best features and spirit of your favorite friend. Our Chihuahua Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Chihuahua Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Boxer Sculptured Portrait $38.95 You will love the fine detail and clever way this Dalmation Portrait captures all the best features and spirit of your favorite friend. Our Dalmation Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Dalmation Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Bulldog Sculptured Portrait $38.95 You will love the fine detail and clever way this Bulldog Portrait captures all the best features and spirit of your favorite friend. Our Bulldog Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Bulldog Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Beagle Sculptured Portrait $38.95 You will love the fine detail and clever way this Beagle Portrait captures all the best features and spirit of your favorite friend. Our Beagle Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Beagle Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

German Shepherd Sculptured Portrait $38.95 You will love the fine detail and clever way this German Shepherd Portrait captures all the best features and spirit of your favorite friend. Our DGerman Shepherd Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful German Shepherd Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Golden Retriever Sculptured Portrait $38.95 You will love the fine detail and clever way this Golden Retriever Portrait captures all the best features and spirit of your favorite friend. Our DGolden Retriever Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Golden Retriever Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Pug Sculptured Portrait Black $38.95 You will love the fine detail and clever way this Pug Portrait captures all the best features and spirit of your favorite friend. Our Pug Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Pug Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Pug Sculptured Portrait $38.95 You will love the fine detail and clever way this Pug Portrait captures all the best features and spirit of your favorite friend. Our Pug Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Pug Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Boston Terrier Sculptured Portrait $38.95 You will love the fine detail and clever way this Boston Terrier Portrait captures all the best features and spirit of your favorite friend. Our Boston Terrier Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Boston Terrier Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Black Lab Sculptured Portrait $38.95 You will love the fine detail and clever way this Black Lab Portrait captures all the best features and spirit of your favorite friend. Our Black Lab Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Black Lab Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

The Sculptured Courtesan $16.68 The Sculptured Courtesan

West Highland Terrier Sculptured Portrait $38.95 You will love the fine detail and clever way this Dalmation Portrait captures all the best features and spirit of your favorite friend. Our Dalmation Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Dalmation Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Cocker Spaniel Sculptured Portrait Black $38.95 You will love the fine detail and clever way this Cocker Spaniel Portrait captures all the best features and spirit of your favorite friend. Our Cocker Spaniel Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Cocker Spaniel Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Jack Russell Terrier Sculptured Portrait $38.95 You will love the fine detail and clever way this DJack Russell Terrier Portrait captures all the best features and spirit of your favorite friend. Our Jack Russell Terrier Portrait will look great displayed on your wall at work or on a mantel at home. Perch this next to a framed photo and you’ll have an instant focal point in your living room. Our delightful Jack Russell Terrier Portrait is made of stone resin and are hand painted to feature exceptional detail. This fine Collectible measures 9" x 11" inches in size.

Montecarlo MC22RBL 4Light Sculptured Fitter Fan Light Kit in Roman Bronze $140.4 This 4Light Sculptured Fitter in a Rich Roman Bronze Finish lets you create a mood a look artistry all your own. It is compatible with 21/4Inch Neck/Neckless Glass and includes 4 40watt bulbs with Lock Ring. Whether its form and style or simple functionality know that Monte Carlo sets the standard for exceptional quality. Renaissance 4 Light FitterLight Kit Fitter. Ceiling Fan LightsPrimary Bulb: 4 Candelabra B10 Torpedo 60w. Number of Bulbs: 4This fixture is EPACT Compliant Click here for more details. 4 x 60 Watt Incandescent Bulbs; Bulbs Included. Lock Ring Included. Bulbs Included. Meets the Energy Policy Act of 2005 (EPACT) energy conservation standards. Finish: Roman Bronze. Dimensions: 145/16 W x 59/32 H. Voltage: 120. Installation: Dry Locations.

Sculptured Stones In The Kirkyard Of Govan $14.4 Sculptured Stones In The Kirkyard Of Govan

Sculptured Tombs of Hellas $22.77 Sculptured Tombs of Hellas

Sculptured Nails And Nappy Hair $16.95 Sculptured Nails And Nappy Hair

Monte Carlo MC22OC Sculptured Four Light Fitter in Old Chicago $133.9 Decorative ceiling fan four light fitter Accomodates four 60 Watt candelabra base bulbs Lock ring for securing light bulbs Bulbs not included Compatible with 2.25 inch neck and neckless accessory glass shades Overall dimensions are 9 inches H x 9.5 inches W

Nuvo Lighting 60585 Triumph 5 Light 24 in. Chandelier with Sculptured Glass Shades $285.99 Number of Lights: 5. Finish: Brushed Nickel. Style: Contemporary. UL Certification: Dry. Energy Saver: N. Energy Star: N. Bulb Included: N. Bulb Base: Medium. Max Wattage: 60w. Lamp Type: Incandescent. Bulb Type: A19. Shade Material: Glass. Shade Description: Sculptured Alabaster. Chain: 48 . Dimensions:. Width: 24 . Height: 21.75

Nuvo Lighting 60589 Triumph 2 Light 16 in. SemiFlush with Sculptured Glass Shades $85.79 Number of Lights: 2. Finish: Brushed Nickel. Style: Contemporary. UL Certification: Dry. Energy Saver: N. Energy Star: N. Bulb Included: N. Bulb Base: Medium. Max Wattage: 60w. Lamp Type: Incandescent. Bulb Type: A19. Shade Material: Glass. Shade Description: Sculptured Alabaster. Dimensions:. Width: 15.5 . Height: 12.25

Nuvo Lighting 60586 Triumph 1 Light 11 in. Flush Mount with Sculptured Glass Shades Pack of 6 $46.79 Number of Lights: 1. Finish: Brushed Nickel. Style: Contemporary. UL Certification: Damp. Energy Saver: N. Energy Star: N. Bulb Included: N. Bulb Base: Medium. Max Wattage: 60w. Lamp Type: Incandescent. Bulb Type: A19. Shade Material: Glass. Shade Description: Sculptured Alabaster. Dimensions:. Width: 11 . Height: 5.25