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Tos P, Fin A, Crosio A, Chen C. Microsurgical reconstruction of the nail. HAND SURGERY & REHABILITATION 2024; 43S:101676. [PMID: 38447746 DOI: 10.1016/j.hansur.2024.101676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
Very often, post-traumatic defects involve multiple tissues. Microsurgical techniques can reconstruct them with tissues taken from a toe: from the nail complex alone to compound osteo-onychocutaneous flaps. Several techniques have been reported since the 1980s. This paper describes techniques and indications for microsurgical nail reconstruction. Technique differs according to the deficit, and first and foremost whether only the nail complex is involved or whether other components of the fingertip important for the normal growth of the nail, such as the phalanx bone or the finger pad, are also missing (toenail flaps and the custom-made osteo-onychocutaneous flaps). For most patients the absence of a fingernail is an esthetic rather than functional concern, and the outcomes of microsurgical reconstruction are far from ideal in this regard. We prefer to reserve reconstruction for symptomatic patients with functional impairment.
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Affiliation(s)
- Pierluigi Tos
- Department of Hand Surgery and Reconstructive Microsurgery, ASST Gaetano Pini-CTO, Via Gaetano Pini 9, 20122 Milano, Italy.
| | - Alessandra Fin
- Department of Hand Surgery and Reconstructive Microsurgery, ASST Gaetano Pini-CTO, Via Gaetano Pini 9, 20122 Milano, Italy
| | - Alessandro Crosio
- Department of Hand Surgery and Reconstructive Microsurgery, ASST Gaetano Pini-CTO, Via Gaetano Pini 9, 20122 Milano, Italy
| | - Chao Chen
- Department of Hand & Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China
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Using 320-detector row computed tomography angiography to investigate the arterial anatomy of the toe flaps on living humans. Surg Radiol Anat 2021; 43:1711-1719. [PMID: 34226966 DOI: 10.1007/s00276-021-02793-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Using 320-detector row computed tomography angiography (320-CTA) to investigate the arterial supply for the toe flaps, namely the anatomical characteristics of the dorsalis pedis artery (DPA), the first dorsal metatarsal artery (FDMA), and the arteries of the first toe web space (AsFTWS). METHODS This was a prospective study on CTA of 72 intact feet of 36 Vietnamese adults who had sequelae of thumb or metacarpal hand amputation, from June 2017 to December 2019, then preoperative CTA images were compared with surgical findings on 31 feet of 29 patients. RESULTS 320-CTA was able to investigate the DPA, FDMA, and AsFTWS in 100% of cases. DPA was absent in 6.9% of cases. The average diameters at its origin and termination were 3.22 and 2.56 mm, respectively. For FDMA, the rates of Gilbert type I, II, and III were 52.8%, 18.1%, and 29.2%; the average diameters at its origin and termination were 1.98 and 1.67 mm, respectively. At the first toe web space, FDMA was dominant in 54.2% of cases; the first plantar metatarsal artery (FPMA) was dominant in 29.2% of cases; both arteries were equally dominant in 16.6%. The average diameter at the origin of the lateral plantar digital artery of the great toe was 1.48 mm, of the medial plantar digital artery of the second toe was 1.21 mm. Preoperative CTA images resembled the surgical findings in all cases. The survival rate of toe flaps was 100%. CONCLUSION The 320-CTA provided proper preoperative images in two and three dimensions, and helped surgeons to establish a preoperative surgical plan, thus increasing the success rate of toe transfer surgery.
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Hemamalini, Manjunatha HN. Variations in the origin, course and branching pattern of dorsalis pedis artery with clinical significance. Sci Rep 2021; 11:1448. [PMID: 33446776 PMCID: PMC7809105 DOI: 10.1038/s41598-020-80555-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Abstract
Pulsations of the dorsalis pedis artery are commonly used to evaluate the peripheral arterial diseases like thromboangiitis obliterans (TAO) or Buerger's disease, in lower limbs. Dorsalis pedis artery is a direct extension from the anterior tibial artery and major vascular supply for the dorsum of the foot. But arterial variations in lower limbs are common due to rich distal anastomoses around the ankle joint. Absence of dorsalis pedis arterial pulse does not indicate peripheral arterial disease always as it is sometimes replaced by the enlarged perforating branch of peroneal artery, it may be absent or very thin, deviate laterally on the dorsum of foot. Aim of the present study is to observe the variations in origin, course and branching pattern of dorsalis pedis artery because of its clinical significance. During routine dissection of lower limbs for undergraduates we came across rare variations in the dorsalis pedis artery in its origin, course and branching pattern. Normal anatomic description was found in 27 limbs. In 13 specimens we noted variations, includes bilateral anomalous origin of dorsalis pedis artery, bilateral lateral deviation of dorsalis pedis artery, double dorsalis pedis artery, trifurcation of dorsalis pedis artery and absence of arcuate artery. Knowledge about the arterial variations around the ankle is important to orthopaedic, vascular surgeons and radiologists to prevent complications during surgical interventions.
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Affiliation(s)
- Hemamalini
- Department of Anatomy, JSS Medical College, JSS AHER, 570015, Mysuru, India.
| | - H N Manjunatha
- Department of Anatomy, JSS Medical College, JSS AHER, 570015, Mysuru, India
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Distal Finger Reconstruction by Bilateral Lateral Hallux Osteo-onychocutaneous Free Flap. Ann Plast Surg 2019; 82:S157-S161. [PMID: 30724823 DOI: 10.1097/sap.0000000000001822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this report, we present our experience on the use of bilateral lateral hallux osteo-onychocutaneous free flaps for reconstruction of distal finger and the aesthetic and functional results of this technique in a series of cases. PATIENTS AND METHODS From February 2005 to May 2015, 7 patients underwent finger reconstruction distal to the distal interphalangeal joint using the bilateral lateral hallux osteo-onychocutaneous free flaps. The mean age was 29.3 years (range, 24-33 years). The lateral hallux osteo-onychocutaneous flaps were harvested from bilateral donor sites. The size of each flap was designed based on the size of half distal finger defect. The lateral hallux osteo-onychocutaneous free flaps from both donor sites were combined to reconstruct the distal finger. More than 50% of hallux nail was preserved in each of donor sites, which was covered with a local flap. RESULTS All flaps used for reconstruction survived without complications after surgery. The average length of follow-up was 93.4 months (range, 16-163 months). All reconstructed distal fingers showed good aesthetic appearance, except one that underwent a secondary debulking procedure. The average total active motion of the finger was 215.7 degrees (range, 200-230 degrees). Neither pain nor numbness sensation in the reconstructed fingers was complained by the patients. The donor site morbidity was minimal. All patients had pain-free and good function outcome in both feet. CONCLUSIONS The use of the bilateral lateral hallux osteo-onychocutaneous free flaps may provide an option for distal finger reconstruction with satisfactory function and anesthetic outcomes with minimal hallux donor site morbidity.
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Cavadas PC, Thione A, Martinez IE. Distal Ulna Reconstruction using the Second Metatarsal: Anatomical Study. J Wrist Surg 2016; 5:160-164. [PMID: 27104084 PMCID: PMC4838476 DOI: 10.1055/s-0036-1581051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/14/2016] [Indexed: 10/22/2022]
Abstract
Background The ulnar head is a key stabilizer of the wrist and forearm. The authors investigated the possibility of using the second metatarsal bone to replace the distal ulna in an anatomical study. Methods The morphology of the distal ulna and the head of the second metatarsal (MT2) were studied using three-dimensional computerized tomographic (CT) scans of the wrist and foot in 52 patients without pathology related to these two areas, and 11 cadaveric specimens. The radius and height of the best-fit cylinder for both epiphyses were measured in the CT scans and compared. In the cadaveric specimens an osteotomy of the metatarsal neck was performed to rotate 90 degrees the head of the MT2 to match the shape of the distal ulna. Results The osseous morphology of the distal ulna and the head of the MT2 are roughly cylindrical, but differently oriented relative to the diaphyseal axes. In the osteotomized cadaveric MT2specimens, the overall morphology was relatively similar that of the distal ulna. The mean length of the MT2 after the osteotomy was 65 mm. Conclusion The head of the MT2 was found to have a similar cylindrical morphology to that of the ulnar head, with a different orientation. The radius of the cylinder was similar, although the height was bigger for the MT2. After a rotation osteotomy of the neck of the MT2 the overall shape and orientation of the epiphysis was more similar to the distal ulna. A vascularized transfer of an osteotomized MT2 would be an option for autologous reconstruction of the distal ulna in selected patients, but further study is needed in terms of the vascular supply, ligamentous reconstruction, and reconstruction of the sigmoid notch. Level of Evidence Therapeutic, level IV.
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Bourke G. Amputations, replantation and thumb reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Second-toe transfer for traumatic thumb amputation in children under 5 years: bone and soft-tissue growth. Tech Hand Up Extrem Surg 2014; 18:175-80. [PMID: 25144356 DOI: 10.1097/bth.0000000000000063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic thumb amputations in children under 5 years are uncommon. The final clinical long-term results have been reported shortly in literature. We report our clinical experience in children under 5 years with traumatic amputation of the thumb that were reconstructed using a second-toe transfer. MATERIALS AND METHODS There were 7 boys and 2 girls between the ages of 1 and 5 years. The follow-up was between 6 and 14 years. The average age at the time of transfer was 2.8 years, and the average follow-up was 10.7 years (range, between 6 and 14 y). The most frequent cause of amputation was avulsion (33.3%). RESULTS All the transferred toes survived and achieved bone union and static 2-point discrimination was averaged at 5 mm. They acquired good prehensile pinch and grasp. All of the structures of the transferred toes showed substantial growth. CONCLUSIONS Second-toe transfer for traumatic amputation of the thumb continues to be one of the best choices. Children require secondary procedures less often and in some cases late functional recovery can be expected. It is a safe procedure and there are fewer complications and a better success rate.
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Hou Z, Zou J, Wang Z, Zhong S. Anatomical Classification of the First Dorsal Metatarsal Artery and Its Clinical Application. Plast Reconstr Surg 2013; 132:1028e-1039e. [DOI: 10.1097/prs.0b013e3182a97de6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Communicating branch of toe web veins as a venous return pathway in free toe pulp flaps. Plast Reconstr Surg 2010; 126:268e-269e. [PMID: 21042087 DOI: 10.1097/prs.0b013e3181ef8158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wavreille G, Cassio JB, Chantelot C, Mares O, Guinand R, Fontaine C. Anatomical bases of the second toe composite dorsal flap for simultaneous skin defect coverage and tendinous reconstruction of the dorsal aspect of the fingers. J Plast Reconstr Aesthet Surg 2007; 60:710-9. [PMID: 17449342 DOI: 10.1016/j.bjps.2007.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Revised: 01/25/2007] [Accepted: 03/13/2007] [Indexed: 11/24/2022]
Abstract
Coverage of the dorsal aspect of the fingers is difficult, especially when the soft tissue defect is large and involves extensor apparatus and joints. Tendinous and/or articular reconstruction is not usually performed simultaneously with cutaneous repair. The aims of this study were: (1) to accurately determine the precise position of the first common dorsal metatarsal artery (FDMA) on the dorsal aspect of the foot, and (2) to enumerate the anatomical structures which could be harvested 'en-bloc' in order to design composite flaps. The precise position of the FDMA was studied from 22 anatomical specimens after selective injection of the arterial network. Its cutaneous area measured 75 x 40 mm on average. The extensor apparatus of the second toe was supplied by the FDMA and its lateral branch to the second toe by 2.7 branches on average over a length of approximately 75 mm. The medial dorsal digital artery was generally the main source of blood supply to the proximal interphalangeal joint (PIP), capsule, ligaments, head of proximal phalanx and base of middle phalanx. It is then possible to design composite flaps including both skin and extensor apparatus, and total or partial PIP joint, if necessary, based on the FDMA and the medial dorsal digital artery, without prejudice to the second toe. The average length of the arterial pedicle (60 mm) makes its suture to the dorsal metacarpal artery, the dorsal carpal branch or the radial artery easy. The harvesting technique for such a flap is described for each anatomical type of FDMA; it has to be adapted to both the type and extent of the defect. Its use is in accordance with the modern classical principle of 'all in one stage with early mobilisation', thanks to adequate coverage whose blood supply does not depend on local vascularisation, and which brings its own physiological vascular supply.
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Affiliation(s)
- G Wavreille
- Department of Anatomy, Faculty of Medicine Henri Warembourg, University of Lille2, 1 Place of Verdun, 59045 Lille cedex, France.
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Abstract
Reconstruction of congenital differences of the hand presents a surgical challenge. Microsurgical toe-to-hand transfer is becoming an accepted treatment for these difficult problems. These transfers can provide functionally useful and cosmetically acceptable digits in children with congenital absence of the thumb, fingers, or both. Currently, the success rate is routinely greater than 95%.
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Affiliation(s)
- Neil F Jones
- UCLA Hand Center, Department of Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, 10945 Le Conte Avenue, #3355, Los Angeles, CA 90095, USA.
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Brown EE, Chang WT, Jones NF. Temporary arteriovenous loop between the saphenous vein and the first plantar metatarsal artery in toe-to-hand transfers. J Hand Surg Am 2006; 31:1543-5. [PMID: 17095388 DOI: 10.1016/j.jhsa.2006.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 08/23/2006] [Indexed: 02/02/2023]
Abstract
We describe a technique for creating a temporary arteriovenous loop by anastomosing the saphenous vein to the first plantar metatarsal artery to facilitate harvesting and subsequent anastomosis of a great or second toe transfer. This technique has been used in 9 patients: 6 pediatric toe-to-hand transfers for congenital hand differences and 3 adult toe transfers for a thumb amputation. All 9 toe transfers survived. The advantages of this technique are that it allows precise determination of the exact length of the loop to reach the recipient artery, it facilitates palmar positioning of the arterial pedicle, and, if necessary, the saphenous vein can be anastomosed directly to the lateral digital artery of a great toe transfer or the medial digital artery of a second toe transfer rather than the first plantar metatarsal artery itself, thereby minimizing more proximal dissection of the first plantar metatarsal artery, which is more difficult and time consuming.
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Affiliation(s)
- Erin E Brown
- Department of Orthopedic Surgery and Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Zhu J, Hu B. Sonography of the first dorsal metatarsal artery of the foot. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:1-4. [PMID: 16353226 DOI: 10.1002/jcu.20174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To describe the gray-scale and Doppler sonographic examination technique and appearances of the first dorsal metatarsal artery (FDMA) of the foot and discuss its clinical significance. METHODS The dorsal arteries of foot-including the FDMA and the first plantar metatarsal artery-of 374 feet were studied using gray-scale and color Doppler sonography. Due to the difficulty of detecting the FDMA, a majority of them were identified by studying the web area just distal to the intermetatarsal space. The interosseous muscle was identified to determine the classification of the anatomic type of the FDMA. The sonographic results of 152 feet were compared with surgical findings. RESULTS The average caliber of the FDMA was 1.0 +/- 0.5 mm. The FDMA was classified into 3 groups of variants based on its relationship with the first dorsal interosseous muscle. The groups were identified as the superficial artery (54.5%), intramuscular artery (39.6%), and submuscular artery (9%) variants. The rates of visualization of the distal and proximal portions of the FDMA were 86.6% and 47%, respectively. In the first intermetatarsal space, there were anastomoses between the FDMA and the first plantar metatarsal arteries in 87.6% of the feet. CONCLUSIONS The FDMA varies greatly; however, sonography can clearly show its morphologic characteristics, such as caliber and location. Sonography also provides valuable preoperative information in microsurgery of the foot.
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Affiliation(s)
- Jiaan Zhu
- Department of Ultrasound, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghhai, 200233, China
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Spanio S, Wei FC, Coskunfirat OK, Lin CH, Lin YT. Symmetry of vascular pedicle anatomy in the first web space of the foot related to toe harvest: clinical observations in 85 simultaneous bilateral second-toe transfer patients. Plast Reconstr Surg 2005; 115:1325-7. [PMID: 15809594 DOI: 10.1097/01.prs.0000156977.13014.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Toe-to-hand transfer is an accepted procedure for reconstruction of thumbs and fingers. Although the vascular anatomy of the toe has been well studied, its symmetry on both feet has not previously been reported. METHODS A retrospective review of 85 cases of simultaneous bilateral toe-to-hand transfers, performed between 1984 and 2002, was carried out. All of the pedicles were dissected in a retrograde fashion. RESULTS A symmetric vascular pedicle anatomy was found in 78.8 percent of the patients, whereas 21.2 percent of the patients had an asymmetric vascular pattern. CONCLUSIONS This result cautions surgeons about the possibility of vascular pedicle asymmetry between two feet in bilateral toe harvest. It proves once more the advantage of a retrograde pedicle dissection technique, which allows for a safe and straightforward toe harvest regardless of the vascular pedicle course variations.
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Affiliation(s)
- Stefano Spanio
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Medical College, Chang Gung University, Taipei, Taiwan
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Xu L, Gu YD, Xu JG, Rui YJ, Shou KS. Microsurgical treatment for bilateral thumb defect: five case reports. Microsurgery 2004; 23:547-54. [PMID: 14705070 DOI: 10.1002/micr.10213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The authors present a new and efficient treatment for reconstruction of bilateral defective thumbs by different configured toe-tissues transplantations in a single stage, including bilateral second-toe transfer in 2 cases, bilateral hallux wrap-around flap transfer in 1 case, bilateral modified hallux wrap-around flap transfer in 1 case, and combined second toe with island flap with neurovascular pedicles from the proximal and dorsal aspect of the index finger transfer in 1 case. In total, eight transferred tissues survived uneventfully after circulation monitor and medicine administration according to the rules of microsurgery, and in two other transferred toe tissues, temporary circulation crises occurred. Over a 1-year follow-up, the satisfactory appearance and excellent function of the reconstructed bilateral thumbs were noted. For ensuring the success of the procedure, the authors emphasize the establishment of a double artery supply and venous return-flow systems and the modification of the hallux wrap-around flap dissection and tendon repair. Meanwhile, three-stage systemically functional rehabilitations also improved functional restoration of reconstructed thumbs.
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Affiliation(s)
- Lei Xu
- Department of Hand Surgery, Hua Shan Hospital, Fudan University, Shanghai, People's Republic of China
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del Piñal F, Herrero F, García-Bernal FJ, Jado E, Ros MJ. Minimizing impairment in laborers with finger losses distal to the proximal interphalangeal joint by second toe transfer. Plast Reconstr Surg 2003; 112:1000-11. [PMID: 12973215 DOI: 10.1097/01.prs.0000076191.07899.96] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traditionally, toe-to-hand transfers have been reserved for thumb amputations or for use after severe mutilating injuries. The authors report their experience with the use of second toe-for-finger amputations with preserved or reconstructible proximal interphalangeal joints in manual workers. The aim of the procedure was to reduce impairment and to upgrade the hand from a functional and cosmetic standpoint. Fifteen second-toe wrap-around or variations were carried out on 11 adults (18 to 41 years old). Four patients with two or more finger amputations received two sequential second toes; four patients with two finger amputations received one toe; and each of three patients with single-digit amputation received a single toe. All but one amputation were performed less than 3 weeks after the accident. All toes survived. Range of motion at the native proximal interphalangeal joint was more than 90 percent in all patients but one; however, it was minimal at the transplanted joints. Patient satisfaction was high from a cosmetic and functional standpoint. Ten of 11 laborers resumed their previous activity. On the basis of this experience, a classification with aesthetic and functional implications is proposed to help in the decision-making process when dealing with multidigital injuries. It is concluded that second-toe transfer is an excellent choice for finger amputation distal to the proximal interphalangeal joint in laborers. Its prime indication is for amputations of two fingers where at least one toe should be transferred, as required, to achieve an "acceptable hand" (three-fingered hand). Early transfer allows salvage of critical structures from the damaged finger, such as joints, tendons, and bone, that otherwise would be lost. Early transplantation is highly recommended.
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Affiliation(s)
- Francisco del Piñal
- Instituto de Cirugía Plástica y de la Mano, the Hospital Mutua Montañesa, and Clínica Mompía, Santander, Spain.
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Martínez Villén G, García Julve G. The arterial system of the first intermetatarsal space and its influence in toe-to-hand transfer: a report of 53 long-pedicle transfers. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2002; 27:73-7. [PMID: 11895350 DOI: 10.1054/jhsb.2001.0659] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A study of the arterial system in the first intermetatarsal space was performed during 53 toe-to-hand or vascularized tissue of the toe transfers with long arterial pedicles. The first dorsal metatarsal artery was used as a single pedicle in 25 transfers and the first plantar metatarsal artery in 21: both arteries were taken simultaneously in seven transfers. In 11 transfers, the dorsalis pedis artery and the perforating branch were absent, although this did not exclude the presence of a first dorsal metatarsal artery which arose from the plantar system by means of an ascending vascular branch in seven cases.
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Affiliation(s)
- G Martínez Villén
- Regional Centre for Surgery of the Hand, Quirón Clinic, Zaragoza, Spain.
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