Anatomical analysis of the cause of skin necrosis of the great toe after transplantation of the great toe nail flap

Management of soft tissue deficiency of the hallux: salvage in trauma, diabetes, and following surgical complications

Loss of the hallux can lead to significant gait problems and cause difficult biomechanical problems with weight bearing. Amputation of the first ray should be avoided when possible. Soft tissue defect of the hallux can be particularly difficult to manage because of the absence of local muscle tissue for coverage. In younger patients, soft tissue loss usually is related to trauma; an understanding of the techniques that are available for coverage are important to maintain length and function of the first ray. Diabetic neuropathy and resultant ulceration of the hallux or metatarsophalangeal joint is another common cause of soft tissue deficiency that may lead to deep infection and potentially result in amputation. Certain systemic problems, such as inflammatory diseases or gout, can cause significant degeneration of the local tissues which also can be problematic. Wound dehiscence or loss of skin flaps that are created during surgery represent further difficulties that may be encountered. This article reviews the common causes of amputation of the hallux and the principles that are necessary for salvage of the digit.

Arteries to the great and second toes based on three-dimensional analysis of 100 cadaveric feet

Three-dimensional arteriography was used to analyse the arterial supply of the great and second toes of 100 cadaveric feet down to the microsurgical level. This information will aid in successful composite tissue transfers of these toes to the hand. The arterial blood supply of the great toe came principally from the first dorsal metatarsal a. (78%) and the first plantar metatarsal a. (22%), and secondarily from the medial tarsal aa. and the three terminal branches of the medial plantar a. For the second toe, the first dorsal metatarsal a. (78%) and the first plantar metatarsal a. (22%) supplied blood from the medial side, and the second dorsal metatarsal a. (78%) and the second plantar metatarsal a. (22%) supplied blood from the lateral side. Seven arterial patterns were found in the interdigital web space. The so-called general pattern was seen in the first web space in 65% of the feet examined. In the second web space it was found in 85%. The first intermetatarsal space sometimes contained a large artery arising directly from the dorsalis pedis or first proximal perforating a. as well as the first dorsal and first plantar metatarsal arteries. In this space, arterial patterns were classified into 4 types and 9 subtypes based on the origins and proximal courses of these arteries. The so-called standard pattern was found in only 19% of the feet, while an arterial pattern with a common proximal trunk on the plantar side for the first dorsal and first plantar metatarsal aa. was found most frequently (46%).(ABSTRACT TRUNCATED AT 250 WORDS)

Microsurgical anatomy in China

This is a general review on the recent advances made in China of microsurgical anatomy. In recent years, more than 300 research papers and a number of monographs on microsurgical anatomy have been published in China. In the research of skin and musculocutaneous flaps, much applied anatomical data about more than 30 new donor areas have been collected and the investigations on the patterns of the blood supply of the flaps are instructively significant to clinical practice. New donor areas have also been introduced for scapular, radial, tibial and other bone flaps, and the range of indications for using the periosteal and cartilaginous flaps has been broadened. On the basis of the technique of superficial lymphaticovenous anastomosis, new information for deep typhaticovenous anastomosis has been provided by clinical anatomists. Through experimental research, the anatomists pointed out that lymphatic vessels with contracting ability should be selected for anastomosis in order to enhance the long term effect of the operation. The successful experiment of bridging the peripheral nerve gap with skeletal muscle, which has been clinically used, has opened up a hopeful prospect for solving the problem of the unavailability of autogenous nerve donors. The identification of nerve fascicles in the nerve trunk provides a morphological basis for the selection of different suture patterns. In addition, much research work has been done on the tranplantation of the suprarenal gland, pancreas, parathyroid gland, testis, kidney of foetus and other small organs.