|Year : 2021 | Volume
| Issue : 4 | Page : 339-347
Use of silicone finger prostheses in amputee patients: An integrative review
François Isnaldo Dias Caldeira1, Victor Alves Nascimento2, Kellen Cristina da Silva Gasque3, Marcela Filié Haddad2
1 Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, School of Dentistry at Araraquara, UNESP- São Paulo State University (FOAr/UNESP), São Paulo, Brazil
2 Department of Clinics and Surgery, School of Dentistry, Federal University of Alfenas, UNIFAL-MG, Alfenas, Brazil
3 Open University of Brazilian Health System, Regional Board of Brasilia, Oswaldo Cruz Foundation (Fiocruz), Brasilia, Brazil
|Date of Submission||26-Apr-2021|
|Date of Decision||19-Sep-2021|
|Date of Acceptance||23-Oct-2021|
|Date of Web Publication||09-Nov-2021|
François Isnaldo Dias Caldeira
Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, School of Dentistry at Araraquara, UNESP- São Paulo State University (FOAr/UNESP), Araraquara, São Paulo
Source of Support: None, Conflict of Interest: None
This study aimed to perform an integrative review of the literature on the use of silicone finger prostheses in amputee patients. Searches were performed in the PubMed, EMBASE, Web of Science, Scielo, and Cochrane Library databases until July 2021. Descriptors used in this article were: Silicone, finger, rehabilitation, and prosthesis. Clinical research and clinical reports on silicone finger prostheses, available in full and in English were included. Initially, 152 articles were identified. After establishing the inclusion/exclusion criteria, 23 studies were identified and constituted the final sample. Regarding the publication date of the included studies, 17.2% of them were published between 2012 and 2016. Most of the rehabilitations occurred in India (69.9%; n = 16), and the mean age of patients who used prostheses was 38.1 years. The level of scientific evidence of the included studies was IV and VI. Therefore, patients rehabilitated with silicone finger prostheses highlighted significant improvements in functional range of motion, restoration of self-esteem, advantages in psychological therapy, more pleasant social interaction, and changes in their quality of life.
Keywords: Finger, prosthesis, rehabilitation, Silicone
|How to cite this article:|
Dias Caldeira FI, Nascimento VA, da Silva Gasque KC, Haddad MF. Use of silicone finger prostheses in amputee patients: An integrative review. J Indian Prosthodont Soc 2021;21:339-47
|How to cite this URL:|
Dias Caldeira FI, Nascimento VA, da Silva Gasque KC, Haddad MF. Use of silicone finger prostheses in amputee patients: An integrative review. J Indian Prosthodont Soc [serial online] 2021 [cited 2022 Aug 20];21:339-47. Available from: https://www.j-ips.org/text.asp?2021/21/4/339/330176
| Introdution|| |
Human hands play important roles in functional movements performed by human beings, as well as, it is fundamental to interpersonal relationships within society. According to Atroshi and Rosberg, finger amputation is the most incident, corresponding to 1.9 in 100,000 individuals.
However, in cases of crushing and severe lacerations in which microsurgical reconstruction by reimplantation is not advisable, finger rehabilitation with silicone prosthesis becomes a viable option to regain hope and make these patients feel comfortable in their social relationships, improvement in the psychological state with the development of personality, increased confidence and acceptance in society, besides recovering the esthetic and functional aspects of the lost limb.,,
The finger prostheses can be constructed by several techniques (suspension with medical glue, vacuum, osseointegrated implants, and mechanical attachment on fingers next to the stump). Considering aesthetics of finger prostheses, they must be made with good-quality silicones, that allow optimal reproduction of skin tone by means of extrinsic pigmentation, drawings of wrinkles, striations, and the characterization of fingernails in acrylic resin.,,,
Thus, for the rehabilitation to become usual, it is recommended to use the silicone technique, because it has higher esthetics, function and presents a low financial cost for the patient. With that in mind, this paper sought to conduct the first integrative review of the literature regarding the use of silicone finger prostheses in amputee patients.
| Material And Methods|| |
Research strategy and information sources
This research is an integrative review produced by following the methodological rigor described by Hermont et al., which contribute to new investigations and clinical resolutions by professionals in the dentistry fields. The studies were analyzed critically according to: (i) Selection of the theme and hypothesis, (ii) Establishment of the inclusion/exclusion criteria of the studies; (iii) Information to be extracted from the articles; (iv) Evaluation of the quality of the studies; (v) Critical analysis of the results and their contributions; (vi) Capacity to produce scientific knowledge.
The central question was framed to address a study question based on population, interest, context: “What are the studies that have evaluated the use of silicone finger prostheses in amputee patients?”
- Population = Patient with the amputated finger
- Interest = Impact of silicone prosthesis
- Context = Rehabilitation of patients with finger prostheses.
The search strategy consisted of a bibliographic survey in PubMed, EMBASE (Excerpta Medica Database), Web of Science, Scielo (Scientific Electronic Library Online), and Cochrane Library databases, until July 2021. English terms used were “silicone” and “finger” and “rehabilitation” and “prosthesis.” The Boolean algorithm “AND” connected the search terms.
Bibliographic searches were exported to the software EndNote Program ™ version X7 (Thomson Reuters, New York, NY, USA) and the duplicates were removed. Review articles, clinical cases of limb rehabilitation, panels, short communications, technical notes, book chapter, in vitro studies, conference abstract publications, and letters to the editor were excluded. Clinical research and clinical articles related to silicone finger prostheses, articles in the English language and available in full were included. The papers were critically appraised in five important methodological steps:
- Exclusion of studies by title and abstract
- Systematic and critical analysis of the information contained in the clinical case reports
- Selection and extraction of data by two independent and calibrated researchers (coauthors F. I. D. C. and V. A. N.). In case of conflicting data and information, a third evaluator (coauthor M. F. H.) was requested
- Critical and systematic investigation of all references, searching for articles without keywords
- Data were classified according to the tool developed by Melnyk and Fineout-Overholt that categorizes the levels of evidence as follows:
- Meta-analysis of controlled studies
- Experimental design studies
- Quasi-experimental design studies
- Experimental studies with nonexperimental design such as descriptive correlational and qualitative research or case studies
- Case reports or data obtained systematically of verifiable quality or program evaluation data
- Qualitative studies
- Opinion of reputable authorities based on clinical competence or opinion of expert committees.
After careful analysis of the evidence levels, data were structured and sorted according to clinical findings on the rehabilitation of patients with silicone finger prostheses as shown in [Table 1]. To highlight the selected articles, they were grouped into themes for discussion.
|Table 1: Studies included in the integrative review about the rehabilitation of patients using silicone finger prostheses|
Click here to view
Two evaluators (N coauthors F. I. D. C. and V. A.N.) assessed the quality of the studies, separately. Any disagreement was resolved through discussion with a third reviewer (coauthor M. F. H.). The Joanna Briggs Institute checklist was used for qualitative studies. Although there is no standard tool for assessing the quality of qualitative studies, this checklist proved to be effective for this type of analysis as described before., Studies were categorized according to the percentage of positive responses. The risk of bias was classified as high (when the study obtained 49% of “yes” responses), moderate (50% to 69% of “yes” responses), or low (70% of “yes” responses). The Effective Public Health Practice Project: Quality Assessment Tool for Quantitative Studies was used for quantitative studies and the articles were scored as strong, moderate, and low as described by Costa et al.
Data from the integrative review were converted into absolute (n) and relative (%) frequencies and analyzed by the statistical software R version 4.0).
| Results|| |
Initially, 152 original articles were obtained and, after removing all duplicates, 109 unique citations were retained. Then, the inclusion/exclusion criteria were established, identifying 23 studies that comprised the final sample, as shown in [Figure 1]. In relation to the level of scientific evidence, the studies were classified as level IV and VI.
|Figure 1: Flow-diagram of the identification, inclusion, and exclusion process|
Click here to view
It was possible to identify that 17.2% of the articles were published in the years 2012 and 2016, and 13.0% in 2014 [Figure 2]a. Most studies describing the rehabilitation with silicone prosthesis for fingers were developed in India (69.9%; n = 16) [Figure 2]b. The age of the rehabilitated patients ranged from 12 to 84 years, with a mean age of 38.1 years [Figure 2]c. Finally, most studies were indexed in PubMed 57.5% (n = 23) [Figure 2]d.
|Figure 2: Main information of the selected articles. (a) Year of publication of the study. (b) Country in which the clinical case report or cross-sectional study was developed. (c) Age of the patients included. (d) Database in which the study is indexed|
Click here to view
[Table 2] represents the methodological quality of the qualitative studies included in this integrative literature review. All the included articles presented low risk of bias, evaluated with 57.2% (n = 12) of yes and five studies reached the maximum score. Questions “4: Is there congruity between the research methodology and the representation and analysis of data?,” “6: Is there a statement locating the researcher culturally or theoretically?,” and “7: Is the influence of the researcher on the research, and vice versa, addressed?” were rated as not applied as they did not fit the type of study. Question nine rated negative.
The methodological quality of the quantitative articles is presented in [Table 3]. Studies scored with maximum values in categories of selection bias, blinding, and data collection methods.
| Discussion|| |
This integrative literature review allowed to highlight studies that have rehabilitated patients with finger prostheses. Identifying such research becomes of fundamental importance since individuals rehabilitated by static or dynamic finger prostheses report an improvement in various functional movements, restoration of the appearance of naturalness, and significant changes in patients' quality of life. Thus, profiles of patients wearing finger prostheses, the use of silicone to manufacture such prosthesis, the use of implant systems, retention devices, and their longevity will be discussed in this review.,
Profile of patients using finger prostheses
There was a proportionality between men and women with amputated fingers. Despite that, longitudinal studies show a prevalence of women rehabilitated with silicone finger prostheses.,, This is justified by the fact that the absence of the limb can significantly interfere with women's social interaction, femininity, and self-confidence, demonstrating that in longitudinal studies the usability and clinical returns were preferentially by female patients.
The mean age of patients rehabilitated with silicone finger prostheses was 38 years, with a range of 12–84 years. Similar results were reported by Bamba et al. in their systematic review of ring avulsion injuries and reaffirmed by Struckmann et al. in their epidemiological studies of finger avulsion. The other significant factor observed in this study was the predominance of clinical case reports in India. The justification for such an incidence is due to the risks of accidents at work, in traffic, and in urban violence. These outcomes could be endorsed by Gupta et al., (2012) in which 26.2% of amputations were associated with accidents at work, as well as 27.8% of cases were related to urban violence and traffic.
Use of silicone in finger prostheses
Studies in this integrative review highlighted the use of silicone as the best material for the rehabilitation of missing fingers.,,,,, A study conducted in India by Kuret et al. assessing the impact of silicone prosthesis on the performance of motor functions in 42 patients showed that the use of the silicone-made prostheses showed higher scores in motor development, as well as in the satisfaction of their usability. Other studies corroborate such findings in India, and in Ghana. Likewise, the use of silicone finger prostheses showed a statistically significant improvement in range of motion, gripping power, cosmetic benefits, and quality of life (psychological state) of patients who opted for this rehabilitation.
Rehabilitation with customized ring wire substructure in finger prosthesis
The use of customized substructures for retention in silicone prosthesis for fingers was another important factor observed in this study. In this sense, a study conducted in India by Ahmad et al. describing the use of a metal substructure for the retention of the silicone prosthesis, showed satisfactory results in relation to the improvement in the psychological state and personality of the patient, after 3-years follow-up. Similarly, the use of structures attached to the prosthesis allowed patients to reestablish self-confidence, function, esthetic sense of the amputated fingers, and the routine use of this artificial finger.,,
Implant-retained finger prosthesis rehabilitation
The use of implant-retained silicone finger prostheses was also observed in this review. This device aims to promote retention and range of static and dynamic movement for the rehabilitated patient. Rehabilitation with a customized abutment (bone-integrated implant) provided the patient with superior retention compared to conventional prostheses, as well as safety in performing movements in India. These results could be reaffirmed in Brazil by Goiato et al., Goiato et al. and in Turkey by Aydin et al. However, it was also observed that the high financial cost of installing bone-integrated implants was considered a limitation for its clinical use.
Longitudinal use of finger prostheses
In this context, rehabilitation using silicone finger prostheses has become a great option for patients, because they have been able to restore function and esthetics as demonstrated in longitudinal studies.
O'farrell et al. evaluated the satisfaction and long-term use of custom-made prostheses in fifty prosthetic fingers. Their results showed that careful manufacturing, optimal installation, and longitudinal follow-up of these patients provide a better quality of life. Similarly, these findings could be reaffirmed by a 3-year follow-up clinical case report and by cross-sectional studies.,
Partial study limitation
The inclusion of longitudinal clinical studies may be a partial limitation of this review, but they were necessary to expand our comprehension on the use of silicone finger prostheses. In addition, it was possible to identify what are the benefits that these prostheses provide to patients in addition to understanding their manufacturing technique.
| Conclusion|| |
Patients rehabilitated with silicone finger prostheses presented significant improvements in functional range of motion, restoration of self-esteem, and changes in quality of life. For this reason, new clinical research on the role and importance of silicone finger prostheses in amputee patients is needed, because the rehabilitation of these individuals is an important factor in functional capacity, providing psychological improvements, as well as promoting a more pleasant social interaction of rehabilitated patients.
We thank the Brazilian Ministry of Education and Culture for sponsoring the Tutorial Education Program - PET at the Federal University of Alfenas for the students' scholarships approved by the 063/2017 call.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Atroshi I, Rosberg HE. Epidemiology of amputations and severe injuries of the hand. Hand Clin 2001;17:343-50, vii.
Kuret Z, Burger H, Vidmar G, Maver T. Impact of silicone prosthesis on hand function, grip power and grip-force tracking ability after finger amputation. Prosthet Orthot Int 2016;40:744-50.
Kuret Z, Burger H, Vidmar G, Maver T. Adjustment to finger amputation and silicone finger prosthesis use. Disabil Rehabil 2019;41:1307-12.
Kumar L, Saloni JR, Mattoo KA, Yadav A. Finger prosthesis with an alternative approach. J Coll Physicians Surg Pak 2012;22:58-60.
Aduayom-Ahego A. Prosthetic rehabilitation of multiple-digit amputa tions using silicone material in sub-Saharan African country Ghana. Pan Afr Med J 2020;36:357.
Aggarwal H, Singh SV, Singh AK, Kumar P, Singh BP. Interdisciplinary approach for somatoprosthetic rehabilitation of a patient with clino-syndactyly and unusual dermatoglyphics. Prosthet Orthot Int 2016;40:763-6.
Mehta S, Agrawal R, Chitikeshi S, Nandeeshwar DB. Rehabilitation of missing digit using customized attachment supported prosthesis. J Indian Prosthodont Soc 2019;19:276-80.
] [Full text]
Mehta S, Leela B, Karanjkar A, Halani AJ. Prosthetic rehabilitation of a partially amputated finger using a customized ring-wire substructure. J Indian Prosthodont Soc 2018;18:82-5.
] [Full text]
Gaikwad AM, Ram SM, Nadgere JB, Shah NP. Recreating first digit with silicone prosthesis. Natl J Maxillofac Surg 2019;10:105-8.
] [Full text]
Hermont AP, Zina LG, da Silva KD, da Silva JM, Martins-Júnior PA. Integrative reviews in dentistry: Concepts, planning and execution. Arq Odontol 2021;57:3-7.
Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia, U.S.: Wolters Kluwer/Lippincott Williams and Wilkins; 2011.
Lockwood C, Munn Z, Porritt KJ. Qualitative research synthesis: Methodological guidance for systematic reviewers utilizing meta-aggregation. JBI Evidence Implement 2015;13:179-87.
Anderson RJ, Bloch S, Armstrong M, Stone PC, Low JT. Communication between healthcare professionals and relatives of patients approaching the end-of-life: A systematic review of qualitative evidence. Palliat Med 2019;33:926-41.
Pennisi PR, Alves NC, Michelin PS, Medeiros-Souza L, Herval ÁM, Paranhos LR. The quality of life of family health professionals: A systematic review and meta-synthesis. Rev Bras Enferm 2020;73:e20190645.
Costa BC, dos Santos Azevedo GS, Ferreira PH, Almeida LM. Probiotics in reducing anxiety and depression symptoms: An integrative review. Health Sci J 2020;10:97-108.
R Core Team. Computing, RFfS. “R: A language and environment for statistical computing.” Vienna: R Core Team (2013).
Asnani P, Shivalingappa CG, Mishra SK, Somkuwar K, Khan F. Rehabilitation of amputed thumb with a silicone prosthesis. J Nat Sci Biol Med 2015;6:275-7.
Aydin C, Karakoca S, Yilmaz H. Implant-retained digital prostheses with custom-designed attachments: A clinical report. J Prosthet Dent 2007;97:191-5.
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.
Bamba R, Malhotra G, Bueno RA Jr., Thayer WP, Shack RB. Ring avulsion injuries: A systematic review. Hand (N Y) 2018;13:15-22.
Struckmann VF, Gaus S, Schilling T, Bickert B, Kneser U, Harhaus L. Digital avulsion injuries: Epidemiology and factors influencing finger preservation. Arch Orthop Trauma Surg 2020;140:1575-83.
Baheti SG, Saraf V, Gangadhar SA, Bhandari AJ, Rahul BS. Finger prosthesis – An attempt to simulate divine creations: A clinical case. Pravara Med Rev 2014;6:20-2.
Jacob PC, Shetty KH, Garg A, Pal B. Silicone finger prosthesis. A clinical report. J Prosthodont 2012;21:631-3.
Jain A, Walker FS, Ugrappa S, Makkad S, Ugrappa VK. Three-part mould technique for fabrication of hollow thumb prosthesis: A case report. Prosthet Orthot Int 2016;40:756-62.
Raghu KM, Gururaju CR, Sundaresh KJ, Mallikarjuna R. Aesthetic finger prosthesis with silicone biomaterial. BMJ Case Rep 2013;2013:bcr2013010385.
Saxena D, Jurel S, Gupta A, Dhillon M, Tomar D. Rehabilitation of digital defect with silicone finger prosthesis: A case report. J Clin Diagn Res 2014;8:ZD25-7.
Tripathi S, Singh RD, Chand P, Mishra N, Yadav LK, Singh SV. A modified approach of impression technique for fabrication of finger prostheses. Prosthet Orthot Int 2012;36:121-4.
Goyal A, Goel H. Prosthetic rehabilitation of a patient with finger amputation using silicone material. Prosthet Orthot Int 2015;39:333-7.
Ahmad M, Balakrishnan D, Narayan A, Naim H. Comprehensive rehabilitation of partially amputated index finger with silicone prosthesis: A case report with 3 years of follow up. J Indian Prosthodont Soc 2014;14 Suppl 1:222-6.
Yadav N, Chand P, Jurel SK. Rehabilitation of single finger amputation with customized silicone prosthesis. Natl J Maxillofac Surg 2016;7:89-91.
] [Full text]
Thomas B, Mathew CA, Perumal M, Marappan M. Osseo integrated finger prosthesis with a custom abutment. J Indian Prosthodont Soc 2017;17:212-6.
] [Full text]
Goiato MC, Mancuso DN, Marques Ferreira PP, dos Santos DM. Finger prosthesis: The art of reconstruction. J Coll Physicians Surg Pak 2009;19:670-1.
Goiato MC, Dos Santos DM, Amoroso AP, Filho HG, De Carvalho Dekon SF. Implant-retained finger prosthesis with modified retention system. Prosthet Orthot Int 2013;37:324-8.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]