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Fang J, Zhang J, Tang JB. Artificial dermal repair for larger finger pulp defects: Satisfactory coverage with limitations in sensation and inevitable scar formation. J Plast Reconstr Aesthet Surg 2024; 96:161-167. [PMID: 39089213 DOI: 10.1016/j.bjps.2024.07.008] [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: 01/22/2024] [Revised: 06/06/2024] [Accepted: 07/08/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND This prospective study aimed to evaluate the outcomes of the use of dermal templates for lengthy volar soft tissue defects (1.5-4 cm) in the fingers. METHODS The volar soft tissue defects of 15 patients (19 fingers) were treated with Lando dermal template coverage between June 2022 and November 2022. We evaluated sensory recovery, scar formation, and overall appearance of the repair site at an average of 13 months (range, 12-17 months) of follow-up. RESULTS The defect healed in all cases. We found an average static 2-point discrimination of 7 mm (range 4 to 14 mm). Scar formation was evident in all cases. The repair did not restore the bulkiness of the volar finger, especially in the finger with the bony exposure. Nail deformities and joint contracture were observed in some cases. CONCLUSION Dermal template repair does not restore normal sensation and inevitably leads to scar formation when the defect is longer (>1.5 cm). Bulkiness of the volar finger is not restored in most patients, especially when there was bone or tendon exposure in the initial wound site.
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Affiliation(s)
- Jialiu Fang
- Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jisen Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
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Venkatramani H, Roberto A, Safa B, Chen C, Lee DC, Chen J. Distal fingertip replantation: indications, strategy and postoperative management. J Hand Surg Eur Vol 2024; 49:403-411. [PMID: 38296251 DOI: 10.1177/17531934241228142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Distal fingertip replantation is associated with being a technically demanding procedure and dubious outcomes, although it is now performed more frequently across the world. However, the technique and outcomes remain controversial with disagreement among replantation surgeons due to lack of consensus about the indications, intraoperative strategy and postoperative regimes. In this article, we asked six experienced hand surgeons several pertinent questions that every replantation surgeon performing distal fingertip replantation would face in their clinical practice. The article summarizes their responses, which might provide valuable insight to every replantation surgeon in different parts of their career while managing these injuries.
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Affiliation(s)
- Hari Venkatramani
- Department of Plastic Surgery, Hand and Reconstructive Microsurgery, Ganga Medical Center and Hospitals Pvt. Ltd., Coimbatore, Tamilnadu, India
| | - Adani Roberto
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | | | - Chao Chen
- Department of Hand and Foot Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, PR China
| | - Dong Chul Lee
- Department of Plastic and Reconstructive Surgery, Kwang-Myung Sung-Ae General Hospital, Gwangmyeong, Republic of Korea
| | - Jing Chen
- Department of Hand Surgery of Jiangsu Province, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
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Tos P, Crosio A, Adani R. Fingertip injuries and their reconstruction, focusing on nails. HAND SURGERY & REHABILITATION 2024; 43S:101675. [PMID: 38432516 DOI: 10.1016/j.hansur.2024.101675] [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: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
The fingertip is a complex anatomical structure that is frequently injured, especially in manual workers. Different classifications have been reported, considering injury orientation, level and geometry. To optimize treatment planning, the area of soft-tissue defect should be considered. Treatment aims to conserve as long a finger as possible, restore sensation (S3 + or more) and ensure a pleasant esthetic appearance. When amputation occurs, the best treatment is replantation when conditions allow. When this is not possible, the fingertip should be used as a composite graft or the nail complex can be grafted and soft tissue reconstructed, according to the preferred method. In defect without amputation or if the distal part of the finger is not present or not useful, many reconstructive techniques have been described. Depending on the injury, patient characteristics and requirements and the surgeon's skills and experience, the treatments vary from secondary healing to free flaps. In this paper, the various treatment options are described and discussed. Nowadays, considering most variables, the best treatment in fingertip injury is secondary healing with occlusive or non-occlusive dressing, even in case of bone exposure. This simple solution is able to restore a nearly normal fingertip with good sensation without further injuring the hand.
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Affiliation(s)
- Pierluigi Tos
- Hand Surgery and Reconstructive Microsurgery Department, ASST Gaetano Pini - CTO, Milan, Italy.
| | - Alessandro Crosio
- Hand Surgery and Reconstructive Microsurgery Department, ASST Gaetano Pini - CTO, Milan, Italy
| | - Roberto Adani
- Hand Surgery Department, Policlinico di Modena, Modena, Italy
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Shi H, Huang Y, Shen Y, Wu K, Zhang Z, Li Q. The first dorsal metacarpal artery flaps versus reverse homodigital dorsal flaps for thumb reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2024; 59:24-31. [PMID: 38407389 DOI: 10.2340/jphs.v59.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/21/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE This review was performed to systematically compare the effectiveness and safety of the first dorsal metacarpal artery flaps (FDMAF) and reverse homodigital dorsal flaps (RHDF) for thumb reconstruction. METHODS All literatures, which compared FDMAF versus RHDF for thumb reconstruction, were acquired through a comprehensive search in multiple databases from inception until 31st August 2022. A meta-analysis was performed using the Cochrane Collaboration's RevMan 5.4 software. RESULTS A total of 19 articles were retrieved, comprising 396 patients in the FDMAF group and 423 patients in the RHDF group. The pooled estimates suggested that there were no significant differences in venous congestion, complications about flap necrosis and reduced range of motion (ROM) of thumb, static 2-point discrimination (S-2PD) between the two groups. On the other hand, patients in the RHDF group had less vascular crisis (odds ratio [OR] = 3.15, 95%CI, 1.31-7.56), complications about poor cortical reorientation (OR = 440.02, 95%CI, 91.97-2105.27) and higher satisfaction rate (OR = 0.56, 95% CI, 0.33-0.96) than those in the FDMAF group. CONCLUSIONS The two surgical procedures were both safe and reliable since no significant differences were found in flap necrosis between the two groups. However, the patients in the RHDF group had less complications about vascular crisis, poor cortical reorientation and higher satisfaction rate. Accordingly, we thought RHDF may be more superior for thumb reconstruction than FDMAF.
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Affiliation(s)
- Haifeng Shi
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
| | - Yongjing Huang
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Yong Shen
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Ke Wu
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
| | - Zhihai Zhang
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Qian Li
- Department of Hand Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
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Li X, Wu X. The microspheres/hydrogels scaffolds based on the proteins, nucleic acids, or polysaccharides composite as carriers for tissue repair: A review. Int J Biol Macromol 2023; 253:126611. [PMID: 37652329 DOI: 10.1016/j.ijbiomac.2023.126611] [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: 05/24/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
There are many studies on specific macromolecules and their contributions to tissue repair. Macromolecules have supporting and protective effects in organisms and can help regrow, reshape, and promote self-repair and regeneration of damaged tissues. Macromolecules, such as proteins, nucleic acids, and polysaccharides, can be constructed into hydrogels for the preparation of slow-release drug agents, carriers for cell culture, and platforms for gene delivery. Hydrogels and microspheres are fabricated by chemical crosslinking or mixed co-deposition often used as scaffolds, drug carriers, or cell culture matrix, provide proper mechanical support and nutrient delivery, a well-conditioned environment that to promote the regeneration and repair of damaged tissues. This review provides a comprehensive overview of recent developments in the construction of macromolecules into hydrogels and microspheres based on the proteins, nucleic acids, polysaccharides and other polymer and their application in tissue repair. We then discuss the latest research trends regarding the advantages and disadvantages of these composites in repair tissue. Further, we examine the applications of microspheres/hydrogels in different tissue repairs, such as skin tissue, cartilage, tumor tissue, synovial, nerve tissue, and cardiac repair. The review closes by highlighting the challenges and prospects of microspheres/hydrogels composites.
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Affiliation(s)
- Xian Li
- Key Laboratory of Medical Cell Biology in Inner Mongolia, Clinical Medical Research Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, China
| | - Xinlin Wu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia Autonomous Region, China.
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Usami S, Kawahara S, Inami K, Hirase Y. Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap. Hand (N Y) 2023; 18:1012-1018. [PMID: 35311361 PMCID: PMC10470249 DOI: 10.1177/15589447221081863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to compare the outcomes of reverse digital artery island flap (RDAIF) in primary and secondary reconstruction after failed replantation or composite graft method. METHODS This study retrospectively analyzed 42 patients that underwent RDAIF (18 primary and 24 secondary). Preoperative details (demographics, injury details, and waiting days) and postoperative outcomes (active arc of proximal interphalangeal [PIP] and distal interphalangeal (DIP) joints, extension loss of PIP, flexion arc of metacarpophalangeal joint, total active motion, flap sensation, the presence of numbness, Tinel's sign and cold intolerance) were evaluated. Quick Disabilities of the Arm, Shoulder, and Hand score (Quick-DASH) and patient satisfaction were also statistically compared between the 2 groups. RESULTS There was no significant difference in patient demographics between the 2 groups in sex, age, smoking and diabetic history, affected hand and finger, injury type and level, and flap area. The only difference was in waiting days. Similar sensory recovery and patient satisfaction were found in both groups. Range of motion in the DIP and PIP joints, extension loss of PIP, total active motion, and Quick-DASH were superior in the primary coverage group. Increasing age, subzone III injury, and secondary reconstruction were found to be the factors that adversely affected the postoperative range of motion. CONCLUSIONS Secondary reconstruction was more likely to result in joint contracture. In the event of a damaged fingertip amputation in older patients, primary flap reconstruction should be considered as the initial treatment of choice, with regard to the ultimate range of motion.
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Affiliation(s)
- Satoshi Usami
- Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopedic Hospital, Tokyo, Japan
| | - Sanshiro Kawahara
- Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopedic Hospital, Tokyo, Japan
| | - Kohei Inami
- Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopedic Hospital, Tokyo, Japan
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Adani R, Petrella G, Corain M, Pantaleoni F. Shape-modified radial forearm flap: does it still have a role in upper extremity reconstruction? HAND SURGERY & REHABILITATION 2023; 42:208-213. [PMID: 36907274 DOI: 10.1016/j.hansur.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES To carry out a radial forearm flap, the radial artery is usually harvested, incurring severe donor site morbidity. Advances in anatomical knowledge discovered constant radial artery perforating vessels, enabling the subdivision of the flap into smaller components suitable for a wide range of differently shaped recipient sites, with marked reduction of downsides. MATERIAL AND METHODS Eight pedicled or free shape-modified radial forearm flaps were used to reconstruct upper extremity defects between 2014 and 2018. Surgical technique and prognosis were examined. Skin texture and scar quality were assessed on the Vancouver Scar Scale while function and symptoms on the Disabilities of the Arm, Shoulder and Hand score. RESULTS At a mean follow-up of 39 months, no cases of flap necrosis, impaired hand circulation or cold intolerance were found. CONCLUSION The shape-modified radial forearm flap is not a new technique, but is poorly known by hand surgeons; in contrast, our experience showed it to be reliable, with acceptable functional and esthetic outcomes in selected cases.
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Affiliation(s)
- Roberto Adani
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanna Petrella
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Corain
- Department of Hand Surgery, University of Verona, Verona, Italy
| | - Filippo Pantaleoni
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Modena, Italy.
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Fritsche E, Giesen T, Hug U. [Littlers Heterodigital Neurovascular Island Flap: Regarding the First Authorship and Our Own Experiences]. HANDCHIR MIKROCHIR P 2023; 55:8-15. [PMID: 36626917 DOI: 10.1055/a-1904-8199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We clarify the claim to the authorship of the first description of the heterodigital neurovascular island flap, describe different variants and present a series of 15 cases with clinical examples.
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Affiliation(s)
- Elmar Fritsche
- Klinik für Hand- und Plastische Chirurgie, Kantonsspital Luzern, Luzern, Switzerland
| | - Thomas Giesen
- Klinik für Hand- und Plastische Chirurgie, Kantonsspital Luzern, Luzern, Switzerland
| | - Urs Hug
- Klinik für Hand- und Plastische Chirurgie, Kantonsspital Luzern, Luzern, Switzerland
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Zang C, Xian H, Zhang H, Che M, Chen Y, Zhang F, Cong R. Clinical outcomes of a novel porcine small intestinal submucosa patch for full-thickness hand skin defects: a retrospective investigation. J Orthop Surg Res 2023; 18:50. [PMID: 36650521 PMCID: PMC9843959 DOI: 10.1186/s13018-023-03531-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate the clinical outcomes of a novel soft tissue repair patch (porcine small intestinal submucosa patch, SIS patch) in the treatment of full-thickness hand skin defects. METHODS From January 2017 to July 2019, 80 patients with hand soft tissue defects, who met the inclusion criteria, were retrospectively reviewed and divided into two groups. After debridement, patients in group A were treated with the novel SIS patch to cover the wound, and patients in group B were treated with autologous skin graft. The dimensions of skin defect area and healing outcome were evaluated and recorded. Scar assessment was carried out using Scar Cosmesis Assessment and Rating Scale (SCAR scale) at the last follow-up postoperation, and the recovery of wound sensation was assessed at the same time using British Medical Research Council (BMRC) grading of sensorimotor recovery. All the data were collected and statistically analyzed. RESULTS A total of 80 patients were enrolled in the study with 40 patients in each group. Four patients in group A and 5 patients in group B were excluded due to wound infection and lost to follow-up. There were 36 patients in group A and 35 patients in group B finally got follow-up postoperation with mean interval of 12.75 ± 5.61 months in group A and 14.11 ± 5.42 months in group B. The dimensions of skin defect area in group A ranged from 7.5 to 87.5 cm2 (mean 25.97 ± 18.66 cm2) and in group B ranged from 7.5 to 86.25 cm2 (mean 33.61 ± 19.27 cm2) which have no significant difference (P > 0.05). SCAR scale results of group A and group B were 10.98 ± 0.33 and 9.49 ± 0.35, respectively, and the difference was statistically significant (P < 0.05). BMRC grading results showed 6 cases of S4, 11 cases of S3+, 5 cases of S3, 6 cases of S2, 6 cases of S1 and 2 cases of S0 in group A, and 8 cases of S4, 10 cases of S3+, 7 cases of S3, 4 cases of S2, 5 cases of S1, and 1 case of S0 in group B, which had no significant difference between them (P > 0.05). CONCLUSIONS The novel SIS patch is an applicable biological material in the treatment of hand skin defect, which could achieve a better cosmetic appearance of the newborn skin tissue.
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Affiliation(s)
- Chengwu Zang
- grid.233520.50000 0004 1761 4404Department of Hand Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 People’s Republic of China
| | - Hang Xian
- grid.233520.50000 0004 1761 4404Department of Hand Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 People’s Republic of China
| | - Hang Zhang
- grid.233520.50000 0004 1761 4404Department of Hand Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 People’s Republic of China
| | - Min Che
- grid.415680.e0000 0000 9549 5392Department of Orthopaedics, Affiliated Central Hospital of Shenyang Medical College, Shenyang, 110020 People’s Republic of China
| | - Yongxiang Chen
- grid.233520.50000 0004 1761 4404Department of Hand Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 People’s Republic of China
| | - Fanliang Zhang
- grid.233520.50000 0004 1761 4404Department of Hand Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 People’s Republic of China
| | - Rui Cong
- grid.233520.50000 0004 1761 4404Department of Hand Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, 710032 People’s Republic of China
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Wang Y, Li X, Lv H, Sun L, Liu B, Zhang X, Xu X. Therapeutic potential of naringin in improving the survival rate of skin flap: A review. Front Pharmacol 2023; 14:1128147. [PMID: 36937856 PMCID: PMC10017745 DOI: 10.3389/fphar.2023.1128147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Naringin is the main component of Drynaria. Modern pharmacological studies have shown that naringin has a wide range of pharmacological activities, including antioxidant, anti-inflammatory, anti-apoptotic, anti-ulcer, and anti-osteoporosis effects. Its therapeutic effects have been observed in various clinical models, such as atherosclerosis, cardiovascular diseases, diabetes, neurodegenerative diseases, and rheumatic diseases. This review investigates the pharmacological effects of naringin and the associated mechanisms in improving flap survival. This review will also provide a reference for future rational application of naringin, especially in research to improve flap survival.
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Affiliation(s)
- Yincang Wang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaodong Li
- The Third Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Hang Lv
- The Third Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Lin Sun
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Bo Liu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaofeng Zhang
- Teaching and Research Section of Orthopedics and Traumatology, Heilongjiang University of Chinese Medicine, Harbin, China
- *Correspondence: Xiaofeng Zhang, ; Xilin Xu,
| | - Xilin Xu
- The Third Department of Orthopedics and Traumatology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
- *Correspondence: Xiaofeng Zhang, ; Xilin Xu,
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Beauty and Function: The Use of Trimmed Great Toe in Thumb and Finger Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4540. [PMID: 36203737 PMCID: PMC9529065 DOI: 10.1097/gox.0000000000004540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022]
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Cheng HT. Free superficial circumflex iliac artery perforator flap for reconstruction of hand web space defect in a patient. Microsurgery 2022; 42:848-849. [PMID: 36169199 DOI: 10.1002/micr.30962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/07/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Hsu-Tang Cheng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taichung, Taiwan.,Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan.,Big Data Center, China Medical University Hospital, Taichung, Taiwan
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