ABSTRACT
In March 2014, a degree V defect of right thumb was reconstructed with a free right hallux nail flap combined with bone and tendon composite tissue of the 2nd toe in the Department of Hand Surgery, Ningbo No. 6 Hospital. A freed right superficial iliac circumflex artery perforator flap (SCIPF) and autologous iliac bone were used to repair the donor site of foot. The hand function was evaluated according to the upper limb function scoring system. Seven years after operation, the function of the right hand was significantly improved and the function of right foot was not significantly affected. According to the Michigan Hand Function Score, the result was 80 point. Functional recovery evaluated according to the Evaluation Standard of Reconstructed Thumb and Finger Functional of Hand Surgery of Chinese Medical Association, the result was excellent (14 point).
ABSTRACT
A patient who suffered with degloving and destructive servered distal segment of the left thumb was referred to the Department of Hand Surgery, Ningbo No.6 Hospital in May 2021. The thumb was reconstructed by transfer and splicing of a free bilateral fibular hallux nail flap. Metatarsal artery of the metatarsal fibular side of the flap was anastomosed to the proper palmar digital artery at the recipient site. The nerve meridian were anastomosed to the proper palmar digital nerve of thumb, and the distal arterial arch of the metatarsal base between the flaps was anastomosed at the same time. A V-Y advancement flap was employed to repair the donor site. After 3 months, the transferred flaps survived well, the left thumb nail grew well, and the dynamic TPD was at 7 mm. According to the Evaluation Standard of Thumb and Finger Reconstruction Function of the Society of Hand Surgery of the Chinese Medical Association, it was evaluated as excellent (14 points). The advancement flap in the donor site survived well, and the walking, running and jumping of both feet were not affected. According to Maryland's foot function scoring standard, it was evaluated as excellent (98 points).
ABSTRACT
Objective To explore the clinical effect of using hallux-nail flap with the distal part of phalanx combined with iliac bone for reconstruction of thumb with Ⅲ degree defect.Methods From June,2011 to June,2016,7 patients with thumb Ⅲ degree defect were treated with the hallux-nail flaps with distal phalanx combined with iliac bone to reconstruct thumbs.According to the thumb defect indexing method reported by Cheng Guoliang,the type 1 of thumb Ⅲ degree defect was 4 cases,and the type 2 of Ⅲ degree defect was 3 cases.The donor site was covered with skin grafting in 1 case,free superficial iliac artery graft in 5 cases and free peroneal artery perforator flap in 1 case.All patients kept the number and length of donor toes.Regular follow-up was performed after operation to observe the function,shape,feeling of finger reconstruction,the survival condition of flaps or skin graft in donor site,etc.It was also observed if the pain by walking actually exists in the long-term effect.Results All of the reconstructed thumbs survived.One patient suffered the necrotic in the donor site repaired by superficial iliac artery flap,which was successfully covered with the skin graft.All patients were followed-up from 3 months to 18 months (mean,8 months).The reconstructed thumb with smooth nail had fine textile and good elasticity,good flexion and extension function of the palm,fingers and the metacarpophalangeal joint.The donor sites recovered with fine texture,and there were no difficulties in walking and running and no complaint about the pain and discomfort.According to the Trial Criteria of Upper Limb Functional Evaluation of Chinese Medical Association Hand Surgery Society,5 cases resulted in excellent,and 2 cases resulted in good.Conclusion The hallux-nail flap with the distal phalanx combined with iliac bone is an excellent option to reconstruct thumb with Ⅲ degree defect with the outcome of good function and appearance.The trauma of the donor site is small and the number and length of the toes are remained.The clinical effect is good.
ABSTRACT
Objective To investigate the hallux nail flap with the tibia lateral diamond shaped flap of the second phalange,joints,tendon combined tissue combination reengineering the surgical methods and clinical effects of thumb.Methods From May,2010 to February,2015,thcrc had fifteen cases of the thumb defect on Ⅱ-Ⅳ degree of the patients in our hospital,and we took anastomosis vascular pedicle of the hallux nail flap and thumb reconstruction with a second phalange with the tibia lateral diamond shaped flap,joint,and tendon composite tissue combination to reconstruct the thumb.The provided district of the second metatarsal was amputated to repair the ligaments between metatarsal bones.And we took the second toe bone nail flap covering the hallux toe area wound in anterograde shift.Results 15 cases of thumb reconstruction survived.The patients were followed-up for 6 to 30 months,the shape of the reconstructed thumb was closed to the contralateral thumb.The thumb to the finger and the palm function was good,two-point discrimination of the finger pulp were 0.6-1.0 cm.According to the upper limb function of the Chinese Medical Association Hand Surgery Society,the upper limb partial function of the evaluation trial standard:excellent in 11 cases,good in 4 cases.The district was recovered well,normal walking and running function were not restricted.Long term follow-up showed no blisters formation and skin ulceration.No nail deformity,good growth.Conclusion The hallux nail flap with the tibia lateral diamond shaped flap of the second phalange,joints,tendon combined tissue combination to reconstruct the thumb of the defect on Ⅱ-Ⅳ degree can restore good function and feeling,but also to have beautiful appearance.It is an effective method for reconstruction of thumb defect on Ⅱ-Ⅳ degree.
ABSTRACT
ObjectiveTo introduce the clinical application of full reconstruction for 72 cases of Ⅳ to Ⅵ-degree finger defect.MethodsFrom December 1998 to December 2010, sixty-three cases (85 fingets) of Ⅳ-degree finger defect, thirty-three cases (49 fingers) of Ⅴ-degree finger defect and 17 cases (23fingers) with Ⅵ-degree finger defect were applied full reconstruction. The procedures of full reconstruction of Ⅳ to Ⅴ-degree finger defect were as follows:Harvest part of nail, skin which includes some skin harvested from dorsal and palmar metatarsal to ensure the length of the reconstructed finger,and dorsal part of distal phalanx from hallux to form a composite flap, which constitute the contour of a finger, and harvesting interphaalangeal joint from the second toes to reconstruct the proximal interphalangeal (PIP) joint. Bone transplantation from the iliac bone to the distal (for Ⅳ-degree and light Ⅴ-degree defect) or both proximal and distal (for severe Ⅴ-degree defect) stump of the reconstructed PIP joint was needed to get to an appropriate length.On the basis of the treatment of Ⅴ-degree defect, reconstruction of Ⅵ-degree finger defect was to harvest one more joint: the metatarsophalangeal joint of the second toe, and connect it with the proximal iliac bone rod.ResultsAbout half of the cases were conserved of 4 toes, and the donor wound of halluxes were covered with the composite flaps (composed of nail, skin) harvested from the second toes which had been sacrificed.The other cases were conserved of all the 5 toes,and the donor wound of halluxes were covered by free flap transplantation.The second toes were reconstituted by bone transplantation from the iliac bones.All of the 157 fingers survived completely, and 75 fingers underwent second-stage plastic surgeries. Sixty-seven fingers underwent second-stage tenolysis surgeries.Follow-ups 7 months to 11 years after surgery, and all the reconstructed fingers had realistic configurations, and the two-point discrimination of the finger pulps ranges from 5 mm to 12 mm. Dorsal extension of the PIP joints were -10°～10°, flexion of the PIP joints range from 55° to 85°,and the average was 76°. ConclusionThe full reconstruction is an ideal alteration for Ⅳ to Ⅵ-degree finger defect reconstruction for the realistic configuration and ideal function of the reconstructed fingers.The one disadvantage of the full reconstruction is that the surgery is much more complex.