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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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The Second Toe-to-Hand Transfer for Full-length Thumb Reconstruction in Congenital Thumb's Grade IIIb to V Hypoplasia: MTPJ Arthrodesis Instead of Tendon Rebalansing. Tech Hand Up Extrem Surg 2019; 24:13-19. [PMID: 31490319 DOI: 10.1097/bth.0000000000000266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital thumb hypoplasia is a rare deformity of the upper extremity. The classification of thumb hypoplasia was created by Blauth in 1967 (types I to V). The base of the first metacarpal bone is absent for hypoplasia types IIIb to V, therefore, toe-to-hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for a successful toe-to-hand transplantation. The aim of this study is to describe a new technique for thumb reconstruction with the second toe transfer and metatarsophalangeal joint (MTPJ) arthrodesis, which can provide a five-digit hand and restore thumb functionality for thumb hypoplasia IIIb to V. We performed second toe-to-hand transplantation with MTPJ arthrodesis for 3 pediatric patients (mean age, 69 mo) with congenital thumb hypoplasia IIIb (n=2), grade V (n=1). Long-term follow-up evaluated the functions and esthetics of the hands for grade IIIb patients (n=2). We believe the second toe transfer with MTPJ arthrodesis transplantation is a promising method for reconstructing a full-length congenital or traumatic thumb absence for the pediatric population.
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Thumb Amputations Treated With Osseointegrated Percutaneous Prostheses With Up to 25 Years of Follow-up. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e097. [PMID: 30788458 PMCID: PMC6365303 DOI: 10.5435/jaaosglobal-d-18-00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Implantation of an osseointegrated percutaneous prosthesis provides a reconstruction alternative for thumb amputation without sacrificing donor tissues. Methods Thirteen thumb amputees received osseointegrated prostheses (1990 to 2014). The treatments were started with custom-designed implants. Since 2005, standardized implant components and structured rehabilitation protocols were introduced. The median follow-up period was 9.5 years. Results Six patients were lost to follow-up. Seven patients (including all six after the introduction of the standardized protocol) had good osseoperception, grip strength (Jamar) was 28.3 kg on the operated side versus 40.4 kg in the unaffected hand (70%), and key grip strength was 6 versus 9.1 kg. Hand function was 94% of the normal hand. The most common complications were mechanical failures necessitating changes of components (eight times in three patients) and superficial infections (seven times in five patients). Five patients had no complications. The refined implant design and new standardized treatment protocol achieved a 100% cumulative success rate with 9.5 years of follow-up so far. Discussion Treatment of thumb amputees using bone-anchored percutaneous prostheses seems to be a safe, durable method with excellent short- and medium-long follow-up results. Severe adverse events are few except for implant loosening which occurred only in the early custom-designed group.
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Abstract
In this article, we review microsurgical reconstructive techniques available to treat thumb amputation at different levels based on our experience. We reference techniques used by other surgeons and identify the most suitable technique for different clinical situations. Indications and techniques for microsurgical partial or composite transfer of the great or second toe for thumb reconstruction are summarized. Different microsurgical transfer techniques suggest a great freedom of surgical choices. However, the choices are considerably restricted if all functional and cosmetic requirements are to be met. We recommend individualized surgical design and reconstruction because each case of thumb amputation is unique.
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Affiliation(s)
- Roberto Adani
- 1 Department of Hand and Microsurgery, University Hospital Modena, Modena, Italy
| | - Sang Hyun Woo
- 2 W Institute for Hand & Reconstructive Microsurgery, W Hospital, Daegu, Korea
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Graham DJ, Venkatramani H, Sabapathy SR. Current Reconstruction Options for Traumatic Thumb Loss. J Hand Surg Am 2016; 41:1159-1169. [PMID: 27916148 DOI: 10.1016/j.jhsa.2016.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 09/23/2016] [Indexed: 02/02/2023]
Abstract
Traumatic loss of a thumb results in notable functional impairment. Multiple reconstructive procedures have been described to address these deficits. Compared with no reconstruction, any procedure is of benefit. However, each of the described methods offers subtle benefits and downsides and may be more applicable in certain situations. We present a review of current reconstructive options for traumatic thumb amputation in 2016.
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Affiliation(s)
- David J Graham
- Department of Hand Surgery, Sydney Hospital, Sydney, New South Wales, Australia.
| | - Hari Venkatramani
- Department of Plastic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Raja Sabapathy
- Department of Plastic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Abstract
The thumb plays an integral role in hand function. Traumatic amputation results in significant morbidity. With loss of the thumb, up to a 40% reduction in hand function may result. Thumb replantation must be attempted when possible. The goals of thumb reconstruction are to replicate normal function as closely as possible, minimize donor site morbidity, and expedite recovery. In the setting of a mutilated hand, the status of the remaining digits must be carefully assessed. Toe transfers, osteoplastic thumb reconstruction, and pollicization are commonly used. This article summarizes the indications and technical considerations in addressing the deficiencies after thumb amputation.
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Affiliation(s)
- David Graham
- Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore 641 043, Tamil Nadu, India
| | - Praveen Bhardwaj
- Hand & Wrist Surgery and Reconstructive Microsurgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India
| | - S Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India.
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Al-Qattan MM, Al-Qattan AM. Defining the Indications of Pedicled Groin and Abdominal Flaps in Hand Reconstruction in the Current Microsurgery Era. J Hand Surg Am 2016; 41:917-27. [PMID: 27450894 DOI: 10.1016/j.jhsa.2016.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/23/2016] [Indexed: 02/02/2023]
Abstract
Three decades ago, pedicled flaps from the groin and abdomen were the workhorses in hand and forearm reconstruction. These pedicled flaps have several disadvantages including patient discomfort, stiffness, the need for flap division, and the inability to elevate the hand after acute trauma. Hence it is not surprising that free flap reconstruction has become the method of choice in coverage of complex hand and forearm defects. Despite this, pedicled flaps may still be indicated in the current era of microsurgery. Based on a review of the literature and the author's experience, the current review defines these indications as follows: complex defects in children aged less than 2 years; coverage of digital stump defects in preparation for toe-to-hand transfer; high-voltage electric burns with the hand surviving on collateral blood supply; salvage of the thumb ray in high-voltage electric burns with concurrent thrombosis of the radial artery; mutilating hand injuries; length preservation of multiple digital amputations in manual workers; and multiple defects within the digits, hand, or forearm. These indications are discussed along with clinical examples.
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Affiliation(s)
| | - Ahmed M Al-Qattan
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia
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Crushed Finger and Its Repair After Placing It Inside an Abdominal Fatty Tunnel for 6 Weeks: A Preliminary Experience Report. Regen Med 2015. [DOI: 10.1007/978-1-4471-6542-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Adani R, Corain M, Tarallo L, Fiacchi F. Alternative method for thumb reconstruction. Combination of 2 techniques: metacarpal lengthening and mini wraparound transfer. J Hand Surg Am 2013; 38:1006-11. [PMID: 23618457 DOI: 10.1016/j.jhsa.2013.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/27/2012] [Accepted: 02/13/2013] [Indexed: 02/02/2023]
Abstract
Amputation at the proximal phalanx or at the metacarpophalangeal joint can be treated by pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, or distraction lengthening. The best technique to use to treat these cases depends on the place of amputation and the patient's age, sex, occupation and functional demands. In the past 6 years, we treated 4 patients by lengthening the thumb metacarpal ray and adding a mini wraparound flap from the great toe. All the subjects were female with an average age of 22 years. All 4 patients had sustained traumatic amputations: 2 at the metacarpophalangeal joint and 2 at the base of the proximal phalanx. Distraction was completed approximately 65 days after osteotomy, obtaining an average lengthening of 23 mm. To achieve bone consolidation, the lengthener was left in place for 127 days on average. Microsurgical thumb reconstruction was performed around 3 months after consolidation of the osteotomy. There were no failures or cases of postoperative vascular compromise. The average pinch power was 66% of the opposite hand. The static 2-point discrimination of the reconstructed thumb was 8 mm (range, 7-10 mm). All patients reported being satisfied with the treatment, although 1 patient was partially dissatisfied due to the prolonged length of the treatment. Donor site morbidity was minimal. This procedure is mainly chosen by selected patients who refuse standard microsurgical thumb reconstruction because it requires a longer treatment period.
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Affiliation(s)
- Roberto Adani
- Department of Hand Surgery, University Hospital of Verona, Verona, Italy.
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Nehete R, Nehete A, Singla S, Adhav H. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation. Indian J Plast Surg 2012; 45:154-7. [PMID: 22754176 PMCID: PMC3385385 DOI: 10.4103/0970-0358.96609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.
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Affiliation(s)
- Rajendra Nehete
- Department of Plastic Surgery, Vedant (Nehete) Hospital, Nashik, Maharashtra, India
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Lin PY, Sebastin SJ, Ono S, Bellfi LT, Chang KWC, Chung KC. A systematic review of outcomes of toe-to-thumb transfers for isolated traumatic thumb amputation. Hand (N Y) 2011; 6:235-43. [PMID: 22942845 PMCID: PMC3153614 DOI: 10.1007/s11552-011-9340-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Toe-to-thumb transfer is an established procedure for reconstruction of traumatic thumb amputations. The four types of toe-to-thumb transfers are the second toe, the great toe, the wrap-around great toe and the trimmed great toe transfers. The purpose of this study is to conduct a systematic review of the literature to compare outcomes amongst different methods of toe-to-thumb transfers. METHODS A literature search using 'toe-to-thumb transfer' combined with 'thumb injury' and 'thumb reconstruction' as keywords and limited to humans and the English language identified 633 studies. Studies were included in the review if they: (1) present primary data, (2) report three or more toe-to-thumb transfers for isolated complete traumatic thumb amputation between the metacarpophalangeal joint and the interphalangeal joint (both excluded) and (3) present functional outcome data. RESULTS Twenty-five studies representing 450 toe-to-thumb transfers met the inclusion criteria. They included 101 second toe transfers, 196 great toe transfers, 122 wrap-around transfers and 31 trimmed toe transfers. The mean survival rate was 96.4%. No statistically significant differences could be detected between the four transfers with regards to survival, arc of motion, total active motion, grip and pinch strength and static two-point discrimination. CONCLUSIONS All four types of toe transfer procedures have predictably high survival rates and good patient satisfaction scores. The current data are inadequate to make any comments with regards to donor site morbidity. Till such data are available, an evidence-based recommendation for the superiority of a specific type of toe-to-thumb transfer cannot be made.
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Affiliation(s)
- Pao-Yuan Lin
- Section of Plastic Surgery, Department of Surgery, Chung Gung Memorial Hospital and Kaohsiung Medical Center, College of Medicine, Chung Gung University, Kaohsiung, Taiwan
| | - Sandeep Jacob Sebastin
- Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore, Singapore
| | - Shimpei Ono
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI USA
| | - Lillian T. Bellfi
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI USA
| | - Kate Wan-Chu Chang
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI USA
| | - Kevin C. Chung
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Medical Center, 1500 E Medical Center Dr, 2130 Tubman Center, Ann Arbor, MI 48109-0340 USA
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Abstract
One-stage osteoplastic reconstruction of the thumb is based on a reverse-flow forearm osteocutaneous flap. It is indicated in traumatic loss of the thumb at or around metacarpophalangeal joint level in situations where replacement with a toe is not feasible or patient desires against such a transfer. It is relatively an easier method of thumb reconstruction and does not require microsurgical expertise. Donor-site morbidity is small. Complications include delayed wound healing at donor site, radius fracture, and venous congestion. This technique is a useful reconstruction option for traumatic loss at the middle-third level of the thumb.
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Osteoplastic Thumb Ray Restoration with or without Secondary Toe Transfer for Reconstruction of Opposable Basic Hand Function. Plast Reconstr Surg 2008; 121:1288-1297. [DOI: 10.1097/01.prs.0000302457.59356.fc] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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