Sunday, April 10, 2016

Finger at Risk- Amniotic Constriction Band

I have previously posted on Amniotic Constriction Band.  I post again on the topic as it is common and sometimes early surgery can be helpful.

This child was born with an abnormality of the hand including a markedly swollen finger.  There are several important findings in these 2 pictures.
Amniotic constriction band with swollen finger.

Amniotic constriction band with swollen finger.
First, there is a well developed thumb and pinky finger.  That means that this child will have excellent function.  Almost all of life's activities can be accomplished with a thumb and one other digit.  This includes writing, typing, grasping large objects, and manipulating small objects.  Clearly, the lack of the central 3 digits will impact dexterity and slow the performance of some tasks.  A child born with this hand will learn how to accomplish tasks and will be more functional, for example, that an adult with a trauma causing the loss of the same digits.

If we look closely at the two pictures, there is a dark cord which can be seen just past the swollen digit.  It is a very small amniotic constriction band.  This band is wrapped around the finger and, when noticed, it can be removed.  These bands are not seen in most patients with amniotic constriction band, but one theory on amniotic constriction band holds that the bands may be the cause of the swelling or even amputation of fingers.  Unfortunately, removing the band does not mean that the finger will survive but it may increase the odds.  Sometimes, there is also an area of scarring which may limit blood flow and release of such an area may also increase the likelihood of survival of the finger.

In this patient, the band was removed and an area of scar tissue released in the hoops of allowing better blood flow.  Unfortunately, fingers with this degree of swelling probably will not survive.  Thankfully, as noted above, this child will have excellent function.

Charles A. Goldfarb, MD
My Bio at Washington University

Monday, April 4, 2016

3D Printed Prosthetic Design

The 3D printed prosthetic( 3DPP) has captured the attention and the imagination of both the general public and the parents of kids with birth and acquired limb loss.  In my opinion, the public envisions the 3D printed prosthetic (3DPP) as a futuristic solution which will eventually become completely life- like.  The parent sees it as a practical, lower cost solution but shares the general hope for the potential of this new technology.  I have shared my thoughts on several occasions: My 3D Posts

A simple Google search generates 500,000+ hits for 3D printed prosthetic (3DPP) but interestingly a search of the medical literature demonstrates less than 5 manuscripts.  So while there is a huge interest in 3D printed prosthetic (3DPP) options, those in the medical field have not necessarily led the way in this revolution.  I hope that this can change and those in medicine can help to refine and improve the 3D printed prosthetic (3DPP) options.

 There are many factors which play into the popularity of the concept of the 3D printed prosthetic (3DPP)- I will share my perceptions.

1) Prior to now, a prosthetic was something that could only be created by a trained prosthetist.  It was labor- intensive and time consuming.  It could be quite expensive.  The 3D printed prosthetic (3DPP) can be created by almost anyone with a knowledge of computers and 3D printers.  It is inexpensive.

2) One of the major limitations up to now was the fact that the growing child required many prostheses through growth.  This required many trips to the doctor and the prosthetist.  It also makes the expensive prosthetic even more expensive as many are required through growth.  This has, therefore, limited the types of prosthetics available to kids.  No one would create a $50,000 dollar prosthetic for a child who would outgrow it in 2 years.  The 3D printed prosthetic (3DPP) changes that paradigm as printing is fast and easy and cheap.

3) Until recently, the goal of a prosthetic was one of two things.  It could be lifelike and as normal appearing as possible OR it could be functional.  But in a low cost device, both together are simply not possible.  Parents and patients would make a choice for one or the other but could not obtain the best of both worlds- both function and appearance.  In adults, only the very expensive myoelectric prosthetic can satisfy both goals.

The 3D printed prosthetic (3DPP) revolution has brought a very different point of view on appearance.  Since the earliest prothetic was printed, these prosthetics have looked different and do not attempt to look like a 'normal' hand.  The very different and colorful appearance has become part of the appeal for kids- the prosthetics give a distinctive look.  Kids are making the prosthetic a part of their identity- a part of who the whole child is.  A recent article summarizes this changing concept: NPR story.  To me, this is a revolutionary change and critically important in supporting the 3D printed prosthetic (3DPP) effort.

I am very excited about the future of prosthetics for kids.  We at the Shriners Hospital in St Louis together with Washington University are working on 3D printed prosthetics (3DPP) and providing myoelectic options.  The other organization making great progress and offering hope to many kids is

Charles A. Goldfarb, MD
My Bio at Washington University