Reconstrucción por técnica de Chevron reverso y transferencia tendinosa con técnica no convencional en Hallux Varus Iatrogénico Severo / Reconstruction by reverse Chevron technique and tendon transfer with unconventional technique in severe iatrogenic Hallux Varus

El Hallux Varus Iatrogénico es una complicación de la cirugía correctiva del Hallux Valgus muy poco frecuente. El tratamiento incluye la intervención de los tejidos blandos, y óseos. El propósito de este trabajo es mostrar los resultados clínico-radiológicos del tratamiento quirúrgico del Hallux Varus Iatrogénico Flexible Severo empleando la combinación de técnicas de reconstrucción alternativas en una paciente femenina de 59 años de edad. Se realizó liberación medial de la capsula articular MTF y abductor, osteotomía de Chevron reverso, artrodesis interfalángica izquierda, transferencia tendinosa del extensor largo de Hallux hacia plantar con botón artesanal. De acuerdo a la Escala AOFAS aumentó de 30 a 90 puntos. Se logró la corrección estable de la deformidad en varo y la consolidación de la osteotomía. El Hallux Varus Iatrogénico es una complicación poco frecuente considerada una deformidad mal tolerada, con pocos casos reportados y pocos reportes. Se debe hacer un enfoque de tratamiento paso a paso para abordar todos los elementos involucrados en el Hallux Varus iatrogénico. La corrección quirúrgica del Hallux Varus iatrogénico severo con técnicas de reconstrucción no convencionales tipo Chevron reverso y transferencia tendinosa con botón plantar, es una excelente opción terapéutica de acuerdo a los resultados obtenidos en este caso(AU)

Iatrogenic Hallux Varus is a very rare complication of Hallux Valgus corrective surgery. The treatment includes the intervention of soft tissues and bones. The purpose of this paper is to show the clinical-radiological results of the surgical treatment of Severe Flexible Iatrogenic Hallux Varus using the combination of alternative reconstruction techniques in a 59-year-old female patient. Medial release of the MTF and abductor joint capsule, reverse Chevron osteotomy, left interphalangeal arthrodesis, tendon transfer of the long extensor of Hallux to plantar with artisanal button was performed. According to the AOFAS Scale, it increased from 30 to 90 points. Stable correction of the varus deformity and consolidation of the osteotomy were achieved. Iatrogenic Hallux Varus is a rare complication considered a poorly tolerated deformity, with few reported cases and few reports. A step-by-step treatment approach must be taken to address all the elements involved in iatrogenic Hallux Varus. Surgical correction of severe iatrogenic Hallux Varus with unconventional reconstruction techniques such as reverse Chevron and plantar button tendon transfer is an excellent therapeutic option according to the results obtained in this case(AU)

Chronic isolated fracture of a metatarsal head in lesser toes treated with open reduction and internal fixation / 中华创伤骨科杂志

Objective:To report our clinical outcomes of open reduction and internal fixation (ORIF) of chronic isolated fractures of a metatarsal head in the lesser toes.Methods:A retrospective consecutive case-series study was performed in 5 patients with symptomatic chronic isolated shear fracture of a metatarsal head in the lesser toes who had been treated from January 2018 to April 2021 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 4 males and one female, with an average age of 26.2 years (from 19 to 36 years) at the time of injury. The fracture had been missed at the initial diagnosis in 2 of the patients. Their main symptom was limited dorsiflexion of the metatarsophalangeal joint (MTPJ). Preoperative X-rays and CT scans revealed dorsal displacement of the distal fragment without dislocation of the MTPJ. All patients were treated by ORIF. Their American Orthopaedic Foot & Ankle Society-lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS), and range of passive dorsiflexion of the MTPJ were compared between preoperation and the final follow-up. Postoperative complications were also recorded.Results:The 5 patients were followed up for an average of 27.8 months (from 6 to 45 months). All the chronic fractures achieved bony union. At the final follow-up, the average AOFAS-LMI score was 90.6 (from 82 to 100), the average VAS score 0 (from 0 to 2), and the average range of passive dorsiflexion of the MTPJ 40.0° (from 35° to 45°), all improved compared with the preoperative values [70.6 (from 59 to 79), 4 (from 2 to 5) and 10.0° (from 5.0° to 10.0°), respectively]. All the patients recovered their activity levels before injury. Three patients developed arthritis of the MTPJ.Conclusion:ORIF may achieve good short- and mid-term clinical outcomes in patients with chronic isolated shear fracture of a metatarsal head in the lesser toes.

A Case Report of Painful Legs and Moving Toes Syndrome and Painful Arms and Moving Fingers Syndrome with Severe Blood Stasis and Panic Disorder Successfully Treated with Tokakujokito-Based Kampo Prescriptions / 日本東洋医学雑誌

The patient was a 47-year-old woman. Four years previously, she began to suffer from left lower leg pain and numbness, and involuntary movements. She received further examination in the department of neurology at other hospitals, but had an uncertain etiology and was provisionally diagnosed with restless legs syndrome. She was treated with Western medicine such as gabapentin and gabapentin enacarbil, but they were ineffective. She subsequently visited our hospital and was hospitalized. She was diagnosed with painful legs and moving toes syndrome, and painful arms and moving fingers syndrome after further examination. We prescribed tokakujokito because she had severe blood stasis and panic disorder on Kamp medical findings. As a result, her left lower leg numbness disappeared and pain was reduced. We report a case of a patient who could not be effectively treated using Western medicine and was successfully treated with tokakujokito-based Kampo prescriptions.

Skin manifestations of COVID-19: A preliminary report on 2 patients and review of related literature

@#CASE SUMMARY: A 51-year-old Filipino female without comorbidities presented with cough, rhinitis, and low-grade fever. Four days later, she developed pruritic, localized wheals on the arms, gradually involving the trunk and lower extremities. A 49-year-old Filipino female without comorbidities based in the Middle East presented with cough and fever. Four days after, she developed a generalized distribution of wheals and livedoid patches on both legs. Both patients recovered from COVID-19 with complete resolution of skin lesions. CONCLUSION: To the best of our knowledge, this is the first report of COVID-19 related dermatology cases collected in the Philippines.

Short-Term Surgical Outcome of the Partial Nail Extraction in Ingrown Nail of Military Trainee: Is Matrixectomy Necessary? / 대한족부족관절학회지

PURPOSE: An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate. MATERIALS AND METHODS: The medical records of patients who had surgical treatment for an ingrown nail in the authors' institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups. RESULTS: The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups. CONCLUSION: In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.

Plane-shaped flap for reconstruction of the web space in polysyndactyly of the fifth toe fused with the fourth toe / 中华医学美学美容杂志

Objective@#To discuss the application of plane-shaped flaps for reconstruction of the web space in polysyndactyly of the fifth toe fused with the fourth toe.@*Methods@#A total of 62 cases (81 feet) with polysyndactyly of the fifth toe fused with the fourth toe were involved in the study, 53 of which were incomplete and 9 were complete fusion of the fourth and fifth toe. The fifth toe showed various degrees of fibular clinodactyly and minor deformities. Excision of polydactyly and then using arthroplasty or osteotomy correction deviation was for fibular clinodactyly. All plane-shaped flaps were used for reconstruction of the web space deeply, and the lateral sides of toes were closed with flaps and the distal soft tissues of polydactyly were used lengthening the reconstructed fifth toe. Brachydactylias were improved, and nail folds were reconstructed. Thus, the appearances reached the normal level.@*Results@#All the webs were reconstructed primarily without skingraft. After 12 months of follow-up, these reconstructed web space were satisfied with good appearances of width, depth and gradient. The fibular clinodactyly was completely corrected, and brachydactylias were corrected in various degrees. Nail folds reached the normal ones.@*Conclusions@#Plane-shaped flap in polysyndactyly of the fifth toe fused with the fourth toe for reconstruction of the web space is satisfactory. The reconstructed webs not only achieves good appearance, but also avoids skin grafts. It is one of the best choices of the polysyndactyly treatment.

Repair of fingertip defect with free second toe tibial flap anastomosed by the dorsal nerve of the toe / 中华整形外科杂志

Objective@#To report the operation methods and clinical effects of repairing finger tip defect with the free tibial dorsal nerve flap of the second toe.@*Methods@#13 patients with finger tip defects were repaired by the tibial dorsal nerve flap of the second toe. The area of finger tip defect was 2.5 cm×1.5 cm-1.3 cm×1.0 cm, and the area of cutting flap was 2.7 cm×1.7 cm-1.5 cm×1.1 cm. All donor site defects on the second toe were covered with full-thickness skin graft.@*Results@#There were 13 cases in this group, and all the flaps and skin grafts were survived. Postoperative follow-up ranged from 6 to 18 months, with an average of 13 months. The appearance of the fingers was satisfied and the sensory recovery was good. Two-point discrimination of the flaps returned to 7-13 mm, with an average of 9 mm. According to the total active move(TAM)scale, results were excellent in 11 fingers, good in 1 finger, and fair in 1 finger. The donor site skin graft was well healed, the second toe pulp was full, and the two-point discrimination of the toe pulps were 6-10 mm, with an average of 8 mm.@*Conclusions@#Compared to the traditional method of repairing finger tip defect with the tibial inherent nerve flap of the second toe, our new method can reduce the damage to the donor site, and we can repair finger tip defect as well as the traditional one at the same time. So it was a better operative method to repair finger tip defect with the tibial dorsal nerve flap of the second toe.

Outpatient Percutaneous Flexor Tenotomy for Diabetic Claw Toe Deformity with Ulcer / 대한족부족관절학회지

PURPOSE: Toe ulcers have been implicated as a causative factor in diabetic foot amputation. The aim of this study was to evaluate the outcomes of percutaneous needle flexor tenotomies of diabetic claw toes with ulcers or pending ulcers. MATERIALS AND METHODS: The authors undertook a retrospective chart review between January 2014 and June 2016 to identify those patients who underwent a percutaneous needle flexor tenotomy for diabetic claw toe deformities. We evaluated 54 toes in 42 patients. Twenty-four patients were female and the mean age at the time of operation was 57 years. The mean follow-up time was 11 months. Thirty-four patients (46 toes) had tip toe ulcers or pending ulcers and 8 patients (8 toes) had dorsal pending ulcers. All patients had palpable pulses and good capillary refill. RESULTS: Forty-three of 46 tip toe ulcers (93.5%) healed without significant complications and 8 dorsal ulcers showed no specific changes within 5 weeks. There were no recurrent ulcers at final follow-up. Four patients developed transfer lesion of the adjacent toe and needed subsequent tenotomy. CONCLUSION: Percutaneous needle tenotomy in an outpatient clinic was an effective and safe method for treating toe ulcers in neuropathic patients to offload the tip of the toe so that ulcer healing could occur.

Achenbach's syndrome: Case report and systematic review of the literature / Síndrome de Achenbach: presentación de un caso y revisión sistemática de la literatura

Abstract Introduction: Achenbach's syndrome is a vascular disorder of the hands and feet. It is of unknown etiology and has a benign course. Because of its low prevalence, available literature is limited, and most publications are case reports. No Latin-American publications were found on the subject. The case of a 58 year-old man is presented, along with a systematic review of the literature to describe its clinical characteristics. Methods: A literature search was conducted in PubMed, Embase and Lilacs using free terms and controlled vocabulary (MeSH, Emtree, and DeCS). Results: An analysis was made on a total of 23 articles, 19 of which were case reports, with a total of 46 patients, 43 women and 3 men, from 7 countries. The disorder occurs most often in women over 50 years, and is manifested by the sudden appearance of a blue coloration of the palmar surface of the fingers. It is less common in the feet. Conclusions: Achenbach's syndrome is benign, and does not require medical intervention. Diagnostic methods are of little use. Therefore, identification is important to avoid unnecessary procedures.

Resumen Introducción: El síndrome de Achenbach es un trastorno vascular de manos y pies, de etiología desconocida y de curso benigno. Dada su baja frecuencia de presentación, la literatura disponible es escasa; la mayoría son reportes de casos. No se encontraron publicaciones latinoamericanas sobre el tema. Aquí se presenta un caso clínico, en un hombre de 58 anos, y se hace una revisión sistemática de la literatura para describir sus características clínicas. Métodos: Se realizó una búsqueda de literatura en PubMed, Embase y Lilacs utilizando términos libres y vocabulario controlado (MeSH, Emtree y DeCS). Resultados: Se evaluaron 23 artículos de los cuales 19 fueron reportes de caso. Los reportes de caso muestran la historia de 46 pacientes, 43 mujeres y 3 hombres, en 7 países. El trastorno se presenta más frecuentemente en mujeres mayores de 50 anos y se manifiesta por la aparición súbita de una coloración azul de la cara palmar de los dedos y menos frecuente en los pies. Conclusiones: El síndrome de Achenbach es benigno y no requiere intervenciones médicas. Los métodos diagnósticos son de poca utilidad. Es necesario reconocerlo para evitar procedimientos innecesarios.

Síndrome vascular acral secundária à neoplasia de pâncreas. Relato de caso e revisão de literatura / Acral vascular syndrome secondary to pancreatic cancer: case report and literature review

Paciente do sexo feminino, de 65 anos, foi admitida em nossa instituição com síndrome do dedo azul. Durante a investigação diagnóstica para as principais etiologias possíveis, foi evidenciado adenocarcinoma de cabeça de pâncreas, tendo sido elaborada associação como manifestação paraneoplásica. A investigação da etiologia da síndrome do dedo azul é de suma importância para a conduta terapêutica adequada, já que as causas podem ter evolução extremamente grave na ausência de intervenção, como é o caso dos pacientes que apresentam tal síndrome secundária à neoplasias.(AU)

A 65-year-old female patient was admitted to our institution with the blue toe syndrome. During the diagnostic investigation for possible etiologies, pancreatic head carcinoma was evidenced, and an association as a paraneoplastic manifestation was established. The investigation of the etiology of the blue toe syndrome is very important for the proper treatment, since the causes may have extremely serious development in the absence of intervention, as it is the case of patients with this syndrome secondary to cancer.(AU)

Clinicopathological analysis of 12 cases of acquired digital fibrokeratoma / 中华皮肤科杂志

Objective To investigate clinical and pathological characteristics of acquired digital fibrokeratoma (ADF).Methods Clinical data were collected from 12 patients with ADF,and their clinical manifestations,histopathological features,treatment and prognosis were analyzed retrospectively.Results The mean age at onset of ADF was 39.75 ± 17.69 years (range,17-64.5 years),and the average disease duration was 4.83 ± 5.77 years (range,0.5-20 years).The ratio of male to female was 1.4:1.Most skin.lesions were polymorphic,and mainly involved fingers,toes and nail grooves.Sometimes non-extremity sites are also involved.Histopathological examination of skin lesions showed epidermal hyperkeratosis,acanthosis and broadened dendroid rete ridges.The dermis consisted of mature collagen bundles,fibroblasts and a large number of dilated capillaries.The characteristic manifestation was that most collagen bundles were vertical to the epidermis.Conclusions ADF,a rare benign fibrous tumor with unknown etiology,usually occurs in adults as a solitary lesion on fingers or toes,sometimes in non-extremity sites.Surgery and laser therapy are common treatments for ADF with low recurrence rate.

Subcutaneous Sarcoidosis Occurring in Both Chin and Toe

Sarcoidosis is a systemic inflammatory disease characterized by non-caseating granulomas of unknown origin. Of the fewer than 6% of sarcoidosis cases that occur in subcutaneous tissue, most occur on the face or forearm, but rarely in the toe. A 33-year-old man was admitted to our institute with a 2-cm mass on his chin and a 0.5-cm mass on his right fourth toe. Based on preoperative ultrasonography, epidermal cysts were suspected, and histopathological tests were performed after removing the masses. Histopathologically, the chin and toe tissue samples showed chronic granulomatous inflammation, without necrosis, indicative of sarcoidosis. Chest computed tomography revealed a large number of small nodules in both the interlobar fissures and the peribronchial area, and a large number of small lymph nodes in both the hilar and interlobar node areas. On the basis of the histopathologic and imaging findings, the patient was diagnosed with sarcoidosis. This very rare case of sarcoidosis, occurring in both chin and toe, suggests that thorough evaluation is needed to find other mass when we find sarcoidosis in facial area.

EFFECT OF SECOND TOE-TO-HAND TRANSFER ON THE PLANTAR PRESSURE DISTRIBUTION OF THE DONOR FOOT

ABSTRACT Objective: To investigate the effect of second toe-to-hand transfer on the plantar pressure distribution of the donor foot. Methods: Twelve normal fresh-frozen cadaveric foot specimens were subjected to an axial load of 600 N. An F-Scan plantar pressure analysis system was used to measure the forefoot plantar pressure. The testing was performed under the conditions of intact second toe, second toe removal with the second metatarsal head reserved, and second toe removal in combination with the distal one-third of the second metatarsal, respectively. Results: The peak pressure of the second metatarsal head was greater than other four forefoot plantar regions. There was no statistically significant change in the forefoot plantar pressure distribution after the second toe was removed (p > 0.05). When the second toe and the distal one-third of the second metatarsal were removed, the forefoot plantar pressure distribution changed significantly (p < 0.05). Conclusions: An intact second metatarsal is essential for the normal distribution of plantar pressure. Removal of the second toe with the second metatarsal head reserved had little influence on the plantar pressure distribution of the donor foot. Removal of the second toe and distal one-third of the second metatarsal resulted in abnormal plantar pressure distribution. Level of Evidence II, Experimental Study.

Painless Limbs and Moving Extremities Syndrome: A Variant of Painful Moving Limbs and Extremities.

Painless limbs and moving extremities is a rare condition. Only few case reports or short series of cases are reported. It is believed to be a variant of painful legs and moving toes. It can affect the lower limbs causing painless moving legs and toes or can affect the upper extremities causing painless moving hands and fingers. Various mechanisms of this condition have been postulated, but it requires further studies regarding the exact mechanism of this type movement and the treatment of choice for this condition. Here a case of painless moving lower extremity and upper limb is described, who showed a good response to combination of clonazepam and gabapentine.

Single Stage Reduction Operation for Treatment of Toe Macrodactyly in Skeletally Immature Patients / 대한정형외과학회잡지

Macrodactyly is one of the most difficult congenital anomalies to treat. Treatment of macrodactyly requires surgical intervention because it gives rise to esthetic, social, and functional disability including difficulty in wearing shoes. A myriad of surgical techniques has been introduced to reduce the size of macrodactyly. However, treatment of toe macrodactyly has not been spotlighted due to less significant functional and social issues compared with finger macrodactyly. We treated two patients with toe macrodactyly by single stage reduction operation.

Macrodactilia: estudo retrospectivo de quatro casos / Macrodactyly: a retrospective study of four cases

INTRODUÇÃO: A macrodactilia é uma anomalia rara e de etiologia desconhecida. Os primeiros casos foram descritos, em 1821, por Klein. Representa aproximadamente 1% de todas as anomalias congênitas. Surge no nascimento e caracteriza-se pelo crescimento dos dedos das mãos, dos pés ou de todo o membro; entretanto, pode se apresentar mais tardiamente, com os sintomas de compressão de nervo, podendo associar-se à síndrome do túnel do carpo. MÉTODOS: Estudo retrospectivo de quatro casos de macrodactilia atendidos no Hospital da Santa Casa Misericórdia de Campo Grande, MS, nos últimos 10 anos. RESULTADOS: Descrevemos quatro casos de macrodactilia, sendo três em quirodáctilos e um acometendo primeiro pododáctilo. Todos os pacientes tratados com procedimentos cirúrgicos, um dos casos com amputação de falanges e metacarpo. CONCLUSÕES: É recomendada a amputação como opção cirúrgica em alguns casos e o tratamento precoce da síndrome do túnel do carpo quando presente.

INTRODUCTION: Macrodactyly is a rare anomaly of unknown etiology. The first cases were described in 1821 by Klein. It represents approximately 1% of all congenital anomalies. It appears at birth and is characterized by excessive growth of the fingers, toes, or of the entire limb; however, its appearance may be delayed, with symptoms of nerve compression, and may present with carpal tunnel syndrome. METHODS: Retrospective study of four cases of macrodactyly treated at the Hospital da Santa Casa Misericórdia in Campo Grande, MS, in the last 10 years RESULTS: We describe four cases of macrodactyly: three in the fingers and one affecting the first toe. All patients were treated with surgical procedures, one with amputation of phalanges and metacarpals. CONCLUSIONS: Amputation is a surgical option recommended in some cases, as is the early treatment of carpal tunnel syndrome.

Refinements of Adipofascial flap for Small Defects of Fingers and Toes: Indication and Surgical Tips

PURPOSE: Reconstruction of small defects of the dorsal fingers and toes is a challenging task. Although adipofascial flap is widely used for these areas, additional refinements are warranted. In this paper, we define the appropriate defect size in the finger and toes that can be treated with the adipofascial flap, refine its surgical indications and present a few surgical tips. MATERIALS AND METHODS: Twelve patients with dorsal defects of the fingers and toes were treated with a random-type adipofascial turn-over flap and skin graft. If the defect area exceeded the size that could be covered by a conventional design, the flap base was designed in oblique or curvilinear fashion to lengthen the flap. For accurate defect coverage, the width of the flap base was designed in an asymmetrical shape depending on the defect configuration, varying the width from 0.3 to 1.0 cm, as opposed to the standard 0.5 to 1.0 cm width. Moreover, the lateral limit of the flap was defined as the lateral axial line. The size of the defect ranged from 3.0×1.7 cm to 1.5×1.3 cm. RESULTS: All flaps survived completely. Gliding function of the hand was well preserved and there was no evidence of tendon adhesion. CONCLUSION: The small defect in the dorsal finger and toe can be defined as less than one phalanx-length, measuring about 3.0×2.0 cm in size. If the defect exceeds this dimension, it is recommended that a different option be considered. We believe the adipofascial flap is an excellent option for treating small defects.

Painful legs and moving toes syndrome in a 16-year-old girl / 소아과

Painful legs and moving toes (PLMT) syndrome is characterized by spontaneous movements of the digits and pain in one or both lower extremities. Of the reported cases, a majority of the patients was female, and the mean age of onset was 58 years. Only one pediatric case has been reported so far. Herein, we report the first adolescent case of PLMT in Korea. A 16-year-old girl complained of tingling pain in the left leg and involuntary movement of the ipsilateral great toe one month after a second untethering surgery. Three years ago, she had undergone untethering surgery to correct lipomeningomyelocele at the S2 level of the conus medullaris. At that time, she was diagnosed with polyradiculopathy at the left L5 level with axonal involvement. We diagnosed her with PLMT syndrome and prescribed gabapentin. Her symptoms diminished within a day. Complete relief from involuntary movement of the toe was achieved within four months. PLMT is a rare syndrome but it should be considered in the differential diagnosis of children and adolescents with limb pain and spontaneous movement in their toes.

Second toe-to-hand transplantation.: A surgical option for hand amputations / Trasplante del segundo dedo del pie a la mano.: Una opción quirúrgica para las amputaciones en la mano

Background: The toe to hand transplantation is a method of reconstruction on the unique or multiple amputations of the fingers. It can be used the whole toe or with certain modifications as a wrap-around flap from the big toe or fingertip. It is a widely accepted option for the thumb. Methods: It is a series of patients with amputation of one or more fingers of the hand were operated with second toe to hand transplantation. The survival was evaluated and the sensory recovery by 2-point discrimination. Results: We practiced 12 transplants, 8 thumb, and 4 in other fingers. Ten were adults and two children. All transplants survived. Two patients required tenolysis flexor. The sensibility was recovered with good 2-point discrimination of 8 mm. Discussion: In the more proximal finger amputations, a second toe is the most appropriate, with lower morbidity of the donor site. The rates of success are between 95 to 100%. We had a success rate of 100%. The resulting defect is in the foot is minimum when the second toe was used. The decision to use one of these techniques depends on the decision and transplant surgeon training. We always used the second toe for transfers to the hand, considering that it will be thinner than the original thumb; our patients had no complaint about the appearance. Conclusion: Toe-to-hand transplantation is a good technique, providing a very good aesthetic appearance and allowing the recovery of sensitivity. The defect that is created in the foot does not produce significant aesthetic and functional alterations.

Antecedentes: El trasplante de un dedo del pie a la mano es un método de reconstrucción en las amputaciones únicas o múltiples de los dedos. Se puede usar el dedo en su totalidad o con ciertas modificaciones como una envoltura de piel y uña, o de la punta del dedo. Es una opción ampliamente aceptada para el pulgar. Métodos: Es una serie de pacientes con amputación de uno o más dedos de la mano, intervenidos con un trasplante del segundo dedo del pie a la mano. Se evaluó la supervivencia del trasplante y la recuperación sensitiva con la discriminación de 2 puntos. Resultados: Se realizaron 12 trasplantes, 8 para el pulgar, y cuatro en otros dedos de la mano. Diez fueron adultos y 2 niños. Todos los trasplantes sobrevivieron. Dos pacientes requirieron tenolisis del flexor. La sensibilidad recuperada fue buena con discriminación de 2 puntos de 8 mm. Discusión: En las amputaciones más proximales de los dedos, un segundo dedo del pie es el más adecuado, con menor morbilidad de la zona donante. La tasa de éxito está entre el 95 a 100%. Nosotros tuvimos un 100%. El defecto resultante en el pie es mínimo cuando se usa el segundo dedo. La decisión de utilizar una de las técnicas de trasplante depende de la decisión y formación del cirujano. Conclusión: Es una buena técnica que brinda una apariencia estética muy buena y permite la recuperación de la sensibilidad. El defecto resultante en el pie no produce alteraciones funcionales ni estéticas significativas.

Clinical value of fetal system ultrasound union real-time three-dimensional ultrasound to diagnose the abnormalities of fetal palms and feet / 重庆医学

Objective To explore the clinical value of fetal syetem ultrasound union real-time three-dimensional ultrasound to diagnose the abnormalities of fetal palms and feet in medium-term pregnancy.Methods The results of fetal syetem ultrasound u-nion real-time three-dimensional ultrasound in 23 675 cases during dmedium-term pregnancy in our department from January 2009 to November 2013 were retrospectively analyzed,including 47 350 palms and feet.Results If using the fetal syetem ultrasound u-nion real-time three-dimensional ultrasound to examine fetal palms and feet more than three times,the display rate of palms and feet was 100.0%,while the first-time display rate of finger and toes was 81.2%,second-time display rate was 97.2% and the third-time and more display rate more thatn 99.8%.136 cases hand-foot deformity were diagnosed,including 37 cases of hand gesture abnor-malities,6 cases of finger abnormalities,93 cases of food abnormalities,and the main abnormality was strephexopodia.Of all the 136 cases,there were 2 cases also with Trisomy 18,4 cases with Trisomy 21.Conclusion Malformations of fetal palms and feet can be detected by fetal system ultrasound combined with real-time three-dimensional ultrasonography during the second trimester,which is important indicators of prenatal screening for chromosomal abnormalities.