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Yang K, Jiuzheng Deng, Pan Y, Yuan Y, Duan G, Zhu J. Secondary Thumb Reconstruction via Ectopic Banking of Bony Phalanges From a Nonreplantable Amputated Thumb: A Follow-Up Study. J Hand Surg Am 2024; 49:607.e1-607.e7. [PMID: 36038426 DOI: 10.1016/j.jhsa.2022.06.027] [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] [Received: 10/25/2021] [Revised: 05/14/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to evaluate the radiological and functional results of secondary thumb reconstruction via ectopic banking of bony phalanges from a nonreplantable amputated thumb. METHODS Thumb reconstruction was performed using the bony phalanges from a nonreplantable amputated thumb that were ectopically banked in a subcutaneous pocket. A wraparound flap was harvested from the ipsilateral great toe and wrapped around the bone graft. After surgery, the results were assessed in terms of infection, range of motion, bone union of the graft, and signs of osseous resorption of the reconstructed thumb. RESULTS Fifteen patients underwent secondary thumb reconstruction using this technique between January 2003 and October 2018. Ten patients were followed up for at least 6 months (6 months to 9 years) and were included in this study. All wraparound flap transfers were viable. No bone graft infection was observed. In the 6 cases in whom the interphalangeal joint was not fused, the interphalangeal joint motion ranged from 5° to 60° with an average of 35.0° ± 15.1°. The metacarpophalangeal joint motion ranged from 5° to 66°, with an average range of motion of 48.2° ± 23.6° for the cases in whom the joint was not fused. In 8 of the 10 patients, the time of bone ectopic banking was within 10 days. In these patients, bone union with no osseous atrophy was observed. In 2 patients whose phalanx was banked for more than a month, different degrees of bone resorption of the grafted phalanx were evident after transplantation, although no further treatment was required. CONCLUSIONS Bony phalanges from a nonreplantable amputated thumb can be ectopically banked and used for secondary reconstruction of the thumb. The duration of banking before thumb reconstruction should be no more than 2 weeks. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Kai Yang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jiuzheng Deng
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yongwei Pan
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Ye Yuan
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guman Duan
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jianjin Zhu
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Turan A. The Pedicled Sensate Osteocutaneous Groin Flap for Reconstruction of the Forearm and Hand. Ann Plast Surg 2023; 91:745-752. [PMID: 38079319 DOI: 10.1097/sap.0000000000003702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND The groin flap is axial pedicled and versatile. Until now, this flap has been used with many modifications for the reconstruction of forearm and hand defects. However, this flap has not been used in forearm, hand, and thumb reconstruction as a pedicled sensate osteocutaneous flap. In this study, a pedicled sensate osteocutaneous groin flap was used for the reconstruction of composite tissue defects on the forearm, hand, and thumb. PATIENTS AND METHODS A pedicled sensate osteocutaneous groin flap was used to reconstruction composite tissue defects on the forearm, hand, and thumb in 7 patients. The mean age of the patients was 42 years. The defects were located on the dorsal surface of the forearm and hand in 2 patients, the dorsal surface of the hand and finger in 2 patients, and the thumb in 3 patients. The dimensions of the flap skin paddle ranged from 7 × 11 cm to 8 × 23 cm, and the dimensions of the bone component ranged from 1 × 1.5 × 3.5 cm to 1 × 1.5 × 5 cm. The mean follow-up duration was 26 months. RESULTS All the flaps survived. Flap debulking was performed using 3 flaps. Sensory recovery in the flaps was completed approximately 18 months after the first operation. When the results of static 2-point discrimination test and Semmes-Weinstein monofilament test were evaluated at 18 months postoperatively, it showed that protective sensation was obtained. Except for 1 patient, motion restriction did not develop in the wrist, elbow, or shoulder joints. An acceptable aesthetic result, minimal donor site deformity, and protective sensation were obtained in all patients. CONCLUSIONS The pedicled sensate osteocutaneous groin flap can be safely used in the reconstruction of forearm and hand composite tissue defects that do not have available vascular structures for free flaps in the recipient area and in thumb reconstruction where toe transfer and pollicization cannot be performed.
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Affiliation(s)
- Aydin Turan
- From the Department of Plastic, Reconstructive and Aesthetic Surgery Department, Gaziosmanpaşa University Medical School, Tokat, Turkey
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Shrestha N, Batajoo S, Jaiswal S, Shrestha OP. Acute Thumb Reconstruction with Iliac Crest Bone Graft and Groin Flap: A Case Report. JNMA J Nepal Med Assoc 2023; 61:731-734. [PMID: 38289797 PMCID: PMC10579738 DOI: 10.31729/jnma.8264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Indexed: 02/01/2024] Open
Abstract
Crush injury with bone loss results in shortening the length of the thumb. Most of the immediate intervention is amputation and stump closure. Revision amputation with stump closure gives loss of functional length and the patient is unable to do daily activities as before. In most of all hand functions, the opposition of the thumb plays an important role. Reconstruction of the thumb with iliac crest bone graft with its functional length is one of the major achievements for the patient. As in our case, the patient is right-hand dominant he is more concerned about the functional length of the thumb, whatever the aesthetic appearance. Here we present a case of a 24-year-old male with thumb reconstruction in a severely injured thumb with loss of bone and soft tissue just distal to the base of the proximal phalanx. Nine months postoperatively, the patient showed a great outcome with restored thumb length, function, grip strength, and a good range of motion. Keywords case reports; injury; thumb.
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Affiliation(s)
- Niresh Shrestha
- Department of Orthopedics, B&B Hospital Pvt. Ltd., Gwarko, Lalitpur, Nepal
| | - Santosh Batajoo
- Department of Orthopedics, B&B Hospital Pvt. Ltd., Gwarko, Lalitpur, Nepal
| | - Sweta Jaiswal
- Department of Orthopedics, B&B Hospital Pvt. Ltd., Gwarko, Lalitpur, Nepal
| | - Om Prasad Shrestha
- Department of Orthopedics, B&B Hospital Pvt. Ltd., Gwarko, Lalitpur, Nepal
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Wang Y, Zhang Q, Gu J, Yuan C, Liu H. Comparison of Treatment Methods of Thumb-Tip Defects With Phalangeal Bone Exposure: Modified Heterodigital Neurovascular Island Flap Versus Free Lateral Great Toe Flap. J Hand Surg Am 2023:S0363-5023(22)00768-7. [PMID: 36801118 DOI: 10.1016/j.jhsa.2022.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 02/23/2023]
Abstract
PURPOSE Modified heterodigital neurovascular island flaps and free lateral great toe flaps are dependable methods for treating thumb-tip defects with phalangeal bone exposure. We retrospectively analyzed and compared the details and results of the two methods. METHODS This retrospective study included 25 patients with thumb injuries with phalangeal bone exposure treated between 2018 and 2021. Patients were categorized as per the following surgical methods: (1) modified heterodigital neurovascular island flap (12 patients, finger flap group) and (2) free lateral great toe flap (13 patients, toe flap group). The Michigan Hand Outcome Questionnaire, aesthetic appearance, Vancouver Scar Scale, Cold Intolerance Severity Score, static 2-point discrimination, Semmes-Weinstein monofilament, and range of motion of the metacarpophalangeal joint of the injured thumb were evaluated and compared. In addition, operation time, hospital stay, return-to-work time, and complications were recorded and compared. RESULTS In both groups, the defect was successfully repaired, with no cases of complete necrosis. The 2 groups had similar mean scores in static 2-point discrimination, Semmes-Weinstein monofilament, range of motion, and Michigan Hand Outcome Questionnaire scores. The aesthetic appearance, scarring, and cold tolerance of the toe flap group were better than the finger flap group. The operation time, hospital stay, and return-to-work time in the finger flap group were shorter than the toe flap group. The finger flap group had 2 complications-a superficial infection and 1 case of partial flap necrosis. The toe flap group had 3 complications-a superficial infection, 1 case each of partial flap necrosis, and partial skin graft loss. CONCLUSION Both treatments can achieve satisfactory results; however, they each have advantages and disadvantages. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Yang Wang
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Qiaochu Zhang
- Dalian Medical University, Dalian, Liaoning Province, China
| | - Jiaxiang Gu
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chaoqun Yuan
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hongjun Liu
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China.
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Dickey RM, Meade AE, Agnew SP, Zhang AY. Treatment of Nonreplantable Total Thumb Amputation at the CMC Level Using Index Finger Pollicization. Hand (N Y) 2022; 17:1154-1162. [PMID: 33487028 PMCID: PMC9608269 DOI: 10.1177/1558944720988074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pollicization of the index finger is a rarely performed reconstructive option for patients with total thumb amputations with nonsalvageable carpometacarpal (CMC) joint and thenar muscles. Successful pollicization can provide basic grasp and pinch to help patients carry out activities of daily living. We present a retrospective review of 4 patients who underwent index finger pollicization for traumatic total thumb amputations. METHODS A retrospective review of 4 cases of pollicization using an injured index finger for traumatic thumb amputation was performed. Patients available for follow-up were contacted for functional assessment. Outcomes including range of motion (ROM), grip strength, key pinch, 2-point discrimination, and Disabilities of the Arm, Shoulder, and Hand score were obtained. Functional thenar muscle and the CMC joint were absent in all cases. Injury mechanism was firework in 2 patients and crush in 2 patients. RESULTS The time from injury to pollicization ranged from 8 days to 17 months. Follow-up time ranged from 10 weeks to 3 years. Three patients regularly used the pollicized thumb in activities of daily living such as writing. Tip pinch and lateral pinch along with grip strength were weak in all cases; the best recorded pinch strength was 24% and grip strength was 25% compared with the contralateral hand. The ROM of the pollicized thumb was limited. CONCLUSIONS Index finger pollicization following total thumb amputation can be a viable last-resort option for patients. The pollicized digit acts as a sensate post and avoids further morbidity from the traumatized extremity.
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Affiliation(s)
- Ryan M Dickey
- University of Texas Southwestern Medical Center, Dallas, USA
| | - Anna E Meade
- University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Andrew Y Zhang
- University of Texas Southwestern Medical Center, Dallas, USA
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Shi J, Sun Y, Han Y, Chai M, Liu H, Wang J. A finite element analysis on the biomechanical performance of implant-retained finger prostheses designed for Asians. J Plast Reconstr Aesthet Surg 2022; 75:4048-4053. [DOI: 10.1016/j.bjps.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/19/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
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Liu Y, Miller EA, Wee CE, Prsic A, Eble DJ, Kao DS. Osteoplastic Thumb Reconstruction in the Immediate Setting: A Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4385. [PMID: 35720199 PMCID: PMC9197346 DOI: 10.1097/gox.0000000000004385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Background Traumatic thumb amputation can have devastating effects on residual hand function. When replantation is not possible, thumb reconstruction is often performed in a delayed manner and may require multiple stages. Furthermore, reconstruction techniques often require microsurgical skills and equipment, which are not readily available at all institutions. This case series illustrates our technique for immediate osteoplastic thumb reconstruction following traumatic amputation. Methods This is a case series involving all patients who sustained unreplantable thumb amputations and underwent immediate osteoplastic thumb reconstruction with bone autograft and pedicled groin flap by the senior author from September 2016 through August 2018. Results Five patients underwent immediate osteoplastic thumb reconstruction during the study period. Total operative time for the initial osteoplastic reconstruction averaged 158 minutes (range 96-290 minutes). In addition to flap division surgery, patients underwent an average of 1.2 revision procedures (range 0-2), primarily for debulking and hardware removal. Patients achieved an average gain in length of 3.3 cm compared with the maximum anticipated length with revision amputation at the time of injury, and had stable clinical outcomes for a minimum of 12 months. Conclusions Osteoplastic thumb reconstruction is a useful technique for thumb reconstruction for select patients following traumatic thumb amputation. Advantages of this approach include shorter overall operative times and hospital length of stay, minimal donor site morbidity, and a straightforward, reproducible technique.
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Affiliation(s)
- Yusha Liu
- From the From the Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Erin A. Miller
- From the From the Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Corinne E. Wee
- Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Adnan Prsic
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Danielle J. Eble
- From the From the Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Dennis S. Kao
- Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Pertea M, Ciobanu P, Velenciuc N, Poroch V, Filip A, Moraru DC, Lunca S, Veliceasa B. Utility of "reposition-flap" in the reconstruction of the avulsed thumb. Medicine (Baltimore) 2021; 100:e27290. [PMID: 34559139 PMCID: PMC8462580 DOI: 10.1097/md.0000000000027290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to "sacrifice" another anatomical region for thumb reconstruction, the "reposition-flap" technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using "reposition-flap" with an O'Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.
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Affiliation(s)
- Mihaela Pertea
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Petru Ciobanu
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Natalia Velenciuc
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- 2nd Surgical Clinic, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Vladimir Poroch
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Palliative Care Department, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Alexandru Filip
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Orthopaedics and Traumatology Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţeinr. 1, Iaşi, Romania
| | - Dan Cristian Moraru
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Sorinel Lunca
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- 2nd Surgical Clinic, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Bogdan Veliceasa
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Orthopaedics and Traumatology Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţeinr. 1, Iaşi, Romania
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Greyson MA, Kinsley S, Talbot SG. Thumb reconstruction by "on-top-plasty" of the long finger. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:87-92. [PMID: 34291122 PMCID: PMC8274534 DOI: 10.1080/23320885.2021.1935965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 61 year old man sustained electrical burns to hands requiring amputation of the right thumb and index finger at the metacarpophalangeal level. The thumb was reconstructed by means of on-top-plasty of the long finger. This is a reliable and safe technique in selected patients with severe, traumatic hand injuries.
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Affiliation(s)
- Mark A Greyson
- Division of Plastic SurgeryDivision of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Kinsley
- Division of Plastic SurgeryDivision of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon G Talbot
- Division of Plastic SurgeryDivision of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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XU LIN, TAN JIA, WEI PINGOU, LUO XIANG, TAN HAITAO, MUDGAL CHAITANYASHAMSUNDER. CLINICAL APPLICATION OF 3D PRINTING TECHNOLOGY FOR PREOPERATIVE PLANNING OF THUMB RECONSTRUCTION. ACTA ORTOPEDICA BRASILEIRA 2021; 29:211-218. [PMID: 34566481 PMCID: PMC8443019 DOI: 10.1590/1413-785220212904235492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/24/2020] [Indexed: 11/21/2022]
Abstract
Objective: This study aimed to explore the clinical application of preoperative precise design for 3D printing and thumb reconstruction, which could help manage the patients with thumb defect and achieve better function and appearance. Methods: This was a retrospective study of 20 patients who underwent the surgery of harvesting toe transplant and thumb reconstruction between January 2015 and December 2016. The 3D model of the thumb defect was created and printed. The dimensions of skin and bones from donor site were precisely designed as reference for surgical operation. The surgery was performed according to the model. Results: Perfect repair of defects was achieved with satisfying appearance and function. The reconstructed thumbs all survived (survival rate of 100%). Follow-up was 3-9 months. The maximum dorsiflexion was 8-30° and the maximum flexion was 38-58°. The two-point sensory discrimination was 9-11 mm. In total, 17 patients reposted “Excellent” satisfaction and three “Good”, each for the reconstructed thumb and hand function, respectively. The satisfaction rate was 85%. Conclusion: Preoperative digital design and 3D printing according to the donor and recipient sites allowed a tailored operation. The operation was more precise, the appearance of the reconstructed thumb was good. Level of Evidence II, Retrospective Study.
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Affiliation(s)
- LIN XU
- Guigang City People’s Hospital, China
| | - JIA TAN
- Guangzhou Medical University First Clinical Medical College, China
| | | | - XIANG LUO
- Guangxi Clinical Research Center for Digital Medicine and 3D Printing, China
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Liu C, Liu L, Liu G, Tian S, Bai J, Yu K, Tian D. Repair of thumb defect by using the toenail flap: biomechanical analysis of donor foot-a retrospective cohort study. J Orthop Surg Res 2019; 14:287. [PMID: 31477182 PMCID: PMC6721015 DOI: 10.1186/s13018-019-1330-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The thumb accounts for 50% of the total hand function. This study reports the functional outcomes and complications of people with traumatic thumb amputations who underwent toe-to-thumb reconstruction. METHODS From January 2013 to January 2018, 29 patients with second-degree thumb defect underwent thumb reconstruction with distal phalangeal braided toenail flap. The footscan foot pressure gait analysis system was used to measure the index changes of the same foot before and after 1, 3 and 6 months. The contact area, peak pressure, impulse value, contact time of each gait phase, centre of gravity coordinate and foot balance were analysed statistically. RESULTS Twenty-nine cases of thumb reconstruction recovered well. After following up for 6-15 months, the appearance of the reconstructed thumb was close to normal, and the sensation was restored to S3+. The two-point discrimination was 6-8 mm, and the function of the thumb was good. The function of the donor foot was well restored, and no skin ulceration, pain and claudication were noted during walking. Compared with that before the operation, the biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress and impulse values of the third metatarsal head were significantly increased, forming a stress concentration area centred on the third metatarsal head. CONCLUSIONS This study confirmed that the toenail flap with distal phalangeal bone restored the second-degree thumb defect without destroying the main functional structure of the sole. The biomechanical indices of the donor foot were basically restored to normal 6 months after the operation. Only the stress concentration area centred on the third metatarsal head, and the pain on the forefoot was induced after the operation. Discomfort, callus formation, metatarsal fasciitis, etc., can lead to fatigue fracture of the third metatarsal bone in severe cases, which requires further follow-up and observation. TRIAL REGISTRATION Clinicaltrials.gov , NCT03879941; registered on 10 March 2019, retrospectively.
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Affiliation(s)
- Chunjie Liu
- Department of Orthopedics, Tangshan Workers Hospital, Tangshan, 063000, Hebei, People's Republic of China
| | - Lei Liu
- Department of Orthopedics, Changping District Hospital, Beijing, 102200, People's Republic of China
| | - Guoli Liu
- Department of Orthopedics, The Second Hospital Of Tangshan, Tangshan, 063000, Hebei, People's Republic of China
| | - Siyu Tian
- Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Jiangbo Bai
- Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Kunlun Yu
- Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Dehu Tian
- Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang, 050017, Hebei, People's Republic of China.
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Adani R, Mugnai R, Petrella G. Reconstruction of Traumatic Dorsal Loss of the Thumb: Four Different Surgical Approaches. Hand (N Y) 2019; 14:223-229. [PMID: 29039226 PMCID: PMC6436130 DOI: 10.1177/1558944717736396] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article outlines our methods for thumb reconstruction following dorsal skin loss injury located between the metacarpophalangeal joint (MPj) and the entire nail affecting skin, nail, tendon, and bone in different combinations but with intact sensate palmar skin. METHODS Between 1990 and 2015, 24 patients were treated for dorsal thumb defects using 4 different surgical techniques. Five cases of dorsal compound traumatic loss were reconstructed by custom-made dorsal great toe transfer. Four patients with dorsal skin and nail loss located at the distal phalanx level were covered with the homodigital flap with reverse flow vascularization. In 9 patients presenting skin defects between the MPj and the nail, reconstruction was achieved by means of the kite flap. Six cases suffered extensive dorsal skin loss, and reconstruction was performed using different types of radial forearm flaps (cutaneous, tendineocutaneous, osteocutaneous, and fascial). RESULTS Flap survival was obtained in all cases. No vascular complications occurred with free vascularized compound toe transfer. CONCLUSIONS Reconstruction of dorsal thumb defects is imperative and its approach is strictly correlated to type of defect, patient's requests, and flap alternatives. For defects with nail involvement, the free osteo-onychocutaneous flap harvested from the great toe provides the best aesthetic result in selected young and well-motivated patients. An alternative is represented by the dorsoulnar flap, when the defect is located distally, or the fascial pedicle radial forearm flap, for major dorsal thumb defects, in patients refusing microsurgical reconstruction. The kite flap still represents a feasible solution for medium-size defects with an intact nail.
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Affiliation(s)
- Roberto Adani
- University Hospital of Modena, Italy,Roberto Adani, Department of Hand Surgery and Microsurgery, University Hospital of Modena, Policlinico, Largo del Pozzo 71, Modena 41124, Italy.
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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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Ju J, Li L, Hou R. Transplantation of a Free Vascularized Joint Flap from the Second Toe for the Acute Reconstruction of Defects in the Thumb and other Fingers. Indian J Orthop 2019; 53:357-365. [PMID: 30967709 PMCID: PMC6415561 DOI: 10.4103/ortho.ijortho_200_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to evaluate a novel surgical method for the acute reconstruction of defects in the thumb and other fingers by transplanting a free vascularized joint flap from the second toe and to determine its clinical curative effects. MATERIALS AND METHODS A free vascularized joint flap from the second toe was transplanted to reconstruct a complete defect of the thumb and other fingers accompanied by the loss of the proximal finger in 10 patients. Of these patients, three had their thumbs reconstructed with a free vascularized joint flap from the second toe and with the proximal interphalangeal joint flap, one had a thumb reconstructed with a free vascularized joint flap from the second toe, and six had their finger defects reconstructed with the proximal interphalangeal joint flap. The toes of the metatarsophalangeal joint were amputated at the foot donor site. All patients underwent one-stage emergency surgery. RESULTS The composite tissue flaps, replanted thumbs, and fingers survived well in all 10 cases. Follow-up visits were conducted for 6-28 months, with an average of 9 months of follow-up. The transplanted bone joints healed over a period of 6-16 weeks. Bone nonunions and refractures did not occur, and the walking function of the foot donor site was not visibly affected. CONCLUSION A free vascularized joint flap from the second toe can be transplanted to repair defects in the thumb and other fingers. This technique can be applied to recover the appearance and function of fingers.
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Affiliation(s)
- Jihui Ju
- Department of Orthopaedics, Ruihua Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Li
- Department of Orthopaedics, Ruihua Affiliated Hospital of Soochow University, Suzhou, China
| | - Ruixing Hou
- Department of Orthopaedics, Ruihua Affiliated Hospital of Soochow University, Suzhou, China,Address for correspondence: Dr. Ruixing Hou, Department of Orthopaedics, Ruihua Affiliated Hospital of Soochow University, No. 5 Tayun Road, Wuzhong District, Suzhou 215104, China. E-mail:
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Osseointegrated Finger Prostheses Using a Tripod Titanium Mini-Plate. Arch Plast Surg 2017; 44:150-156. [PMID: 28352604 PMCID: PMC5366522 DOI: 10.5999/aps.2017.44.2.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/15/2016] [Accepted: 10/18/2016] [Indexed: 11/14/2022] Open
Abstract
Background Digital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients. Methods A retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded. Results Seven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported. Conclusions When autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.
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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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Quijano LM, Lynch KM, Allan CH, Badylak SF, Ahsan T. Looking Ahead to Engineering Epimorphic Regeneration of a Human Digit or Limb. TISSUE ENGINEERING. PART B, REVIEWS 2016; 22:251-62. [PMID: 26603349 PMCID: PMC4892205 DOI: 10.1089/ten.teb.2015.0401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/24/2015] [Indexed: 01/08/2023]
Abstract
Approximately 2 million people have had limb amputations in the United States due to disease or injury, with more than 185,000 new amputations every year. The ability to promote epimorphic regeneration, or the regrowth of a biologically based digit or limb, would radically change the prognosis for amputees. This ambitious goal includes the regrowth of a large number of tissues that need to be properly assembled and patterned to create a fully functional structure. We have yet to even identify, let alone address, all the obstacles along the extended progression that limit epimorphic regeneration in humans. This review aims to present introductory fundamentals in epimorphic regeneration to facilitate design and conduct of research from a tissue engineering and regenerative medicine perspective. We describe the clinical scenario of human digit healing, featuring published reports of regenerative potential. We then broadly delineate the processes of epimorphic regeneration in nonmammalian systems and describe a few mammalian regeneration models. We give particular focus to the murine digit tip, which allows for comparative studies of regeneration-competent and regeneration-incompetent outcomes in the same animal. Finally, we describe a few forward-thinking opportunities for promoting epimorphic regeneration in humans.
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Affiliation(s)
- Lina M. Quijano
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana
| | - Kristen M. Lynch
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana
| | - Christopher H. Allan
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Stephen F. Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tabassum Ahsan
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana
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Reconstruction of the Traumatized Thumb. Plast Reconstr Surg 2015; 136:113e-114e. [PMID: 25851450 DOI: 10.1097/prs.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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