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Shen XF, Khoo SS. Advances in Pediatric Toe Transfers. Hand Clin 2024; 40:237-248. [PMID: 38553095 DOI: 10.1016/j.hcl.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Microsurgery is undoubtedly the pinnacle of hand surgery. Significant advancement in recent years has stretched the indications for toe-to-hand transfer in both acquired and congenital hand defects to restore function, esthetics, and motion, with minimal morbidity to the donor site. There is no one fixed microsurgical transfer technique but a surgeon's versatility and innovation in using what one could spare because each case is unique. Esthetic refinements and reducing donor site morbidities have taken a front seat in recent years. We present a few cases to put forward the senior author's preferred techniques with this objective in mind.
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Affiliation(s)
- Xiao Fang Shen
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, 92 Zhongnan Street, Suzhou Industrial Park, Suzhou, Jiangsu 215025, China.
| | - Saw Sian Khoo
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
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Das De S. The Role of Microsurgery in Coverage of Defects of the Hand. Hand Clin 2024; 40:221-228. [PMID: 38553093 DOI: 10.1016/j.hcl.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Soft tissue defects of the hand may result from trauma, infection, vascular disease, and after resection of tumors. Microsurgery has evolved to a stage where it is relatively commonplace today but procedures such as free flaps still incur significant time, manpower, cost, and material resources. The aim of this article is to articulate the specific situations in hand reconstruction when microsurgery is superior to nonmicrosurgical reconstructive options. The benefits of microsurgical reconstruction include a variety of important metrics, such as improved function, better tissue match, less donor site morbidity, and reduced downtime for the patient.
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Affiliation(s)
- Soumen Das De
- Department of Hand and Reconstructive Microsurgery, National University Health System, 1E Kent Ridge Road, Singapore 119228.
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Battiston B, Ciclamini D, Tang JB. Compound or Specially Designed Flaps in the Lower Extremities. Clin Plast Surg 2020; 47:535-546. [PMID: 32892799 DOI: 10.1016/j.cps.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Novel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular.
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Affiliation(s)
- Bruno Battiston
- U.O.C. Traumatology, Hand Surgery, Microsurgery, A.S.O. Città della Salute e della Scienza, CTO - Hospital, Via Gianfranco Zuretti, 29, 10126 Torino, Italy.
| | - Davide Ciclamini
- U.O.C. Traumatology, Hand Surgery, Microsurgery, A.S.O. Città della Salute e della Scienza, CTO - Hospital, Via Gianfranco Zuretti, 29, 10126 Torino, Italy
| | - Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
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Abstract
Microsurgical tissue transfer may provide reconstructive option for extensive loss of tissues due to upper extremity trauma or tumor resection. This article reviews the authors' experience in using microsurgical tissue transfers for reconstruction of upper extremity trauma.
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Affiliation(s)
- Chao Chen
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
| | - Zeng Tao Wang
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China; Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
| | - Li Wen Hao
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
| | - Lin Feng Liu
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
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Kobayashi K, Masuyama N, Nishimura K. Aesthetic Reconstruction of Fingers and Thumbs With the Vascularized Half-Big Toenail Flap With Minimum Donor Site Morbidity. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:203-211. [PMID: 35415504 PMCID: PMC8991767 DOI: 10.1016/j.jhsg.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The vascularized half–big toenail flap is a short-pedicle free vascularized flap approximately 30 mm in size that contains a fibular half-nail with a 5-mm skin edge and the partial distal phalanx bone. The fingertip skin of the amputated finger is reflected to cover the skin deficiency. The sensation and function are maintained at the donor site, and primary wound closure of the donor site is possible. This study aimed to evaluate the clinical outcomes of thumb and finger reconstruction operations performed using this flap. Methods We assessed 16 patients (19 digits) with digit amputation who underwent this procedure. We evaluated the following parameters: reconstructed digits, amputation level, survival rate, period until bone union, elongated length, morphologic indices, feeding artery, vein distribution, static 2-point discrimination, and patient occupation. We used the Michigan Hand Outcomes Questionnaire for the evaluation of the function and appearance of the arm. Results We reconstructed 3 thumbs and 16 fingers. No patients with zone I or V or palm amputation underwent surgery. Flap survival was obtained in all cases, including one atrophic case. Elongated length was 14.1 mm (range, 0–30 mm). The width and longitudinal/axial convexity of the transferred nail increased and the length decreased, whereas the width of the donor site nail increased at final follow-up. Reasonable sensation of the flap was obtained. The feeding artery was the plantar digital artery in 15 toes, the branch in 1, and the arterial anonymous vessel in 3. We could harvest the vein in the first web in 16 toes. All patients went back to their former jobs. Conclusions The aesthetic and functional outcomes of the reconstructed thumbs and fingers significantly improved. Donor site functional morbidity was minimum. Nevertheless, patients’ expectations regarding the reconstructed digit seemed to be that of an intact digit. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Koichi Kobayashi
- Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki City, Kanagawa Prefecture, Japan
- Corresponding author: Koichi Kobayashi, MD, Department of Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki City, Kanagawa Prefecture 211-8510, Japan.
| | - Naoko Masuyama
- Department of Orthopaedic Surgery, Tokyo Takanawa Hospital, Tokyo, Japan
| | - Ken Nishimura
- Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki City, Kanagawa Prefecture, Japan
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Battiston B, Ciclamini D, Tang JB. Compound or Specially Designed Flaps in the Lower Extremities. Clin Plast Surg 2017; 44:287-297. [PMID: 28340663 DOI: 10.1016/j.cps.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Novel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular.
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Affiliation(s)
- Bruno Battiston
- U.O.C. Traumatology, Hand Surgery, Microsurgery, A.S.O. Città della Salute e della Scienza, CTO - Hospital, Via Gianfranco Zuretti, 29, 10126 Torino, Italy.
| | - Davide Ciclamini
- U.O.C. Traumatology, Hand Surgery, Microsurgery, A.S.O. Città della Salute e della Scienza, CTO - Hospital, Via Gianfranco Zuretti, 29, 10126 Torino, Italy
| | - Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
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Zhu ZW, Zou XY, Huang YJ, Liu JH, Huang XJ, He B, Wang ZT. Evaluation of sensory function and recovery after replantation of fingertips at Zone I in children. Neural Regen Res 2017; 12:1911-1917. [PMID: 29239339 PMCID: PMC5745847 DOI: 10.4103/1673-5374.219053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, repair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replantation of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation provides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.
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Affiliation(s)
- Zhao-Wei Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province; Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiao-Yan Zou
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yong-Jun Huang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
| | - Jiang-Hui Liu
- Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xi-Jun Huang
- Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Bo He
- Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zeng-Tao Wang
- Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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Abstract
BACKGROUND Fingertip injury requiring flap cover is very common in the modern era. The ideal cover should fulfill both functional and aesthetic improvement. MATERIALS AND METHODS From June 2015 to April 2016, we performed seven free toe pulp flaps for finger defect reconstruction. All patients were males. Five flaps were done in emergency post-traumatic cases, and two were done in elective set up. The cases included reconstruction of three thumbs, one index and one ring finger in an emergency set up and two ring fingers in the elective. Thumb reconstruction was done with great toe lateral pulp and the other digits reconstructed with second toe pulp flap. Follow-up evaluation included both functional and aesthetic assessment. RESULTS Five flaps survived completely, one suffered partial loss, and one flap failed completely. The median follow-up period was 9 months. The median duration of surgery was 255 min (range 210 to 300 min). The median two-point discrimination was 6.5 mm (range 4-8 mm). There was the return of temperature sensation in all patients; two had cold intolerance. The Semmes-Weinstein monofilament score varied from 3.61 to 5.07 (median filament index value 4.31/pressure value of 2 g/mm2). Three patients had delayed donor site wound healing. CONCLUSIONS The free toe pulp flap is an efficient choice for fingertip and volar finger defects reconstruction with an excellent tissue match.
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Affiliation(s)
- Jyoshid R. Balan
- Department of Plastic Surgery, Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
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Nikkhah D, Orfaniotis G, Nicoli F, Ciudad P, Chen HC. Optimizing donor site outcomes after microsurgical proximal interphalangeal joint transfer using the bone-peg technique. J Plast Reconstr Aesthet Surg 2015; 68:874-6. [DOI: 10.1016/j.bjps.2015.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
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