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INTRODUCTION@#Interdigital pilonidal sinus is an acquired condition secondary to penetration of hair fragments into the skin of the web spaces of the hands commonly observed in hairdressers, and occasionally, among pet groomers. Local literature reports or guidelines to ensure practice of protective measures for this population of workers are currently lacking.@*CASE SUMMARY@#A 24-year old pet groomer consulted due to occasional white hair strands emerging from two openings in the third interdigital space of his dominant hand. Histopathologic examination of the sinus tract showed an acanthotic, hyperplastic epidermis with scale crust, and nodular dermal infiltrates composed of epithelioid histiocytes, plasma cells, lymphocytes, and eosinophils. Transepidermal extrusion of polarizable hair cortical material was also evident establishing the diagnosis of an interdigital pilonidal sinus. Sinusectomy and debridement with healing by secondary intention resulted in an optimal wound closure and full motion of the affected hand after one week and minimal scarring with no recurrence after seven months.@*CONCLUSION@#Surgical excision followed by proper wound care is essential to avoid recurrence. In conclusion, since interdigital pilonidal disease is a rare condition, awareness among physicians would lead to accurate diagnosis, optimal treatment, and proper patient education.
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Occupational Diseases , Grooming , Extremities , Pilonidal SinusABSTRACT
Calcifying aponeurotic fibromais an uncommon,benign fibroblastic tumor which has a preference forneighborhood invasion and a high relapse rate.Henceforth, precise preoperative analysis andcomplete extraction are imperative to counteract therecurrence of the tumor after careful surgical removal.We report a case of 75 year old man with left hand firstweb space calcified aponeurotic fibroma with distinctradiological and MRI features.
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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.
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PURPOSE: In many cases, electric burn can affect regional MCP joint or web space of hand, and reconstruction of these area is significant, because it can lead severe functional and aesthetical impairment of hand. Considering many respects like hand anatomy, flap characters, functional and aesthetical results, we applied reverse adipofascial flap and report the effectiveness of this method. METHODS: From June 2010 to January 2014, 21 cases of electric burn at MCP joint or web space area were reconstructed with reverse adipofascial flaps. Within a week after theses injuries, we performed a debridement of the necrotic tissue. After elevation adipofascial flap under the skin, the flap was transferred to defect site and then we performed STSG over the flap. The donor site was closed primarily. RESULTS: Complete flap survival was achieved in 75.5% of total cases. And the partial necrosis was occurred in 7 cases. There were no other complications and satisfaction of patient survey was performed by 'Likert scale, 1~5 points', the average point was 4 that meant significantly good result. CONCLUSION: Like fasciocutaneous flap or free flap, the adipofascial flap can cover soft tissue defect with exposed or injured tendon or bone because it has good vascularity. Also, compared with other flaps, it has suitable for MCP joint or web space area in respect of flap size or bulkiness and it has more aesthetical advantages. In conclusion, adipofacial flap can be considered as appropriate method to reconstruction of electrical injury at regional MCP joint area and web space.
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Humans , Burns, Electric , Debridement , Free Tissue Flaps , Hand , Joints , Necrosis , Skin , Tendons , Tissue DonorsABSTRACT
Objective To summarize and investigate the therapeutic effects of reconstruction of contracture of the first web space with snuff-box flap. Methods Eighteen patients with contracture of the first web space were treated by snuff-box flap. The width and the angle of the first web space was 19 mm and 20°on average. According to the first web space skin defects, the flap designed to nasopharyngeal fossa centers as rotation point, the radial line when the forearm in the neutral position as the axis. Results The followedup for 5-26 months revealed that 17 flaps had a success, but 1 case was partly necrosis. The width of the first web space was augmented by an aveage of 45 mm, the angle of the first web space was augmented by an average of 50°. Conclusion It is ralatively simple and reliable to repair the contracture of the first web space using the snuff-box flap.
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Objective To investigate the methods and the therapeutic effects of groin flap and stylus recurrent branch of radial artery flap for the repair of severely contracture of the first web space. Methods From March 2007 to six 2009,45 patients with severely contracture of the first web space received treatment of groin flaps and stylus recurrent branch of radial artery flaps, with 6 to 12 months clinical observation. Among then, 33 patients received treatment of groin flaps, 12 patients received treatment of stylus recurrent branch of radial artery flaps, and 28 patients received the first web space widening as well as functional reconstruction of thumb abduction. Results Most of the flaps healed by first intention but also with distal necrosis for 3 stylus recurrent branch of radial artery flaps and 1 groin flap. And the weth of the first web space of all patients were more than 90% of comparison. From clinical observation,function of opposition recovered well. While some groinflaps got a litte fat and clumsy .The color of most flaps was as similar as normal besides, some groin flaps occurrenced pigmentation. Conclusion Children and adults below 50 yesrs should choose the groin flap, and aged people and adults more than 50yesrs shuould choose the stylus recurrent branch of radial artery flap firstly.
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Objective To introduce the therapeutic measure of preventing the first web contracture after hand crush injury in early stage. Methods Three types were divided according to the traumatic condition in 57 cases: closed injury, open injury and with blood vessel of thumb or fingers injury, and used different method such as closing injury postpone, opening the first web by kischner wire or mini-external fixation splint and covered by local or island flap to cure each type in primary and early stage, after 6 months, measured the width and angle of the first web. Results Forty-one cases were followed-up after 3 months - 2 years,abduction and opposition of the thumbs were fine, the average of width and angle of the first web were (5.89 ± 0.58)cm and (87.85 ± 6.03)°. Conclusion The key points of preventing the first web contracture after crush injury are opening the first web that being covered by local flap and to use splint in primary stage.
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Objective To assess and review the methods of the reversed posterior interosseous artery flap for treating the contracture of the first web space. Methods Forty-two cases of the first web space severe contracture were cured by the reversed posterior interosseous artery flap rotate at 1.5-2.0 cm proximal ulnar styloid process after release the adhesion. After operation curative effects were evaluated by measuring the first web space with Gu's method. Results The flap of 42 cases obtain success, however 3 cases was partly necrosis of epidermis. Follow-up examination was obtained in 31 cases for average 18 months after operative.The width of the first web space was augmented an average of 37.9 mm. Rehabilitation training after operation can enhance the effect of the therapy with 8.6 mm more expanded. Conclusion The flap is an ideal choice for treatment on the defect of the contracture of the first web space and rehabilitation training after operation is important.
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Objective To summarize the result of several kinds of flaps treated to first web space contraction. Methods Thirty-two cases of sever contracture of the first web space were treated between September 2000 and March 2009. Ultrathin groin flap, blood vessel pedicle reverse-flow island flap, neurocutaneous flap of the forearm, and free skin flap were used. The area of flaps were 3.0 cm × 5.0 cm-4.5 cm× 8.0 cm.The therapeutic result was observed by 3-12 months follow-up. Results There were partial necrosis at the distal part of flap in 1 case of nerve nutritional vascular pedicle skin flap and 1 case of ultrathin groin flap.The raw surface was healed by free skin grafting. The other flaps were all survived. There was some contraction observed in some patients after the K-wire released. The width of the first web space was augmented to an average of 50 mm (35-60 mm) and account to 80% to the uninjured side. The angle of the first web space was increased to an average of 70°(45°-80°). The contracture was improved significantly. The abduction and opposition function of thumb were restored. There was some degree decrease of grasp strength. The patients can fulfil daily life and partial work. But sensation was not good in some patients. The contour of the flaps:the contour of ultrathin groin flap was good. The contour of flaps in 3 cases of island skin flaps, 1 case of nerve nutritional vascular pedicle skin flap and 2 cases of free flaps were trimmed again in order to be improved. Conclusion The sever contracture of the first web space could be treated by different kinds of flaps, the suitable management should be chosen according to the specific situation.
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Objective To introduce our experiences of reconstruct the first web space using flaps.Methods One hundred and twelve patients sustained contracture of the first, summarized the indications of different flaps in coverage of the first webspace and their prognosis of these flaps were retrospectively reviewed.Results The local flaps, such as double Z-plasty or Z-plasty, were suitable to cover minor contracture of the first webspace; the dorsal flap arising from the index finger was suitable for the coverage of the medium contracture, and the posterior interosseous artery flap or the reverse antebrachial island flap based on the dorsal branch of the anterior interosseous artery suitable for the severe cases. Conclusion The usage of flaps is important to resume the cosmetic shape and function of the first webspace after release of the contracture of the first webspace.
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PURPOSE: The loss of web space is caused by congenital syndactyly or acquired burn injury, trauma or surgery. Numerous surgical procedures have been described for restoration of the web space. Local flaps are usually preferred because of the easiness to perform and tolerable postoperative outcome. Among the various local flaps, the authors introduce V-M plasty for correction of web space contracture and syndactyly. METHOD: From March 2007 to Jun 2008, 4 patients underwent V-M plasty for correction of web space contracture and syndactyly. V-M plasty consists of 3 distinct triangular flaps. One triangular flap is designed next to the web region on the dorsal site of the hand, whereas the remaining 2 triangular flaps are placed on the volar site. The dorsal triangular flap is then placed between the volar adjacent triangular flaps. At the end of the operation, the involved fingers or toes are positioned in abduction to avoid kinking of the triangular flaps. RESULT: All the patients gained web functions with good esthetic appearance without any recurrence or complications. Mean follow-up was 8 months. CONCLUSION: V-M plasty is a safe, easy and rapid procedure to design and apply by using local tissues without the needs for a skin graft or risk of linear scarring and recurrence. The authors advise this versatile technique both in primary and recurrent cases of web space contracture and syndactyly.
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Humans , Burns , Cicatrix , Contracture , Fingers , Follow-Up Studies , Hand , Recurrence , Skin , Syndactyly , Toes , TransplantsABSTRACT
PURPOSE: First web space contracture of the hand has been treated with various surgical techniques such as Z-plasty, local flap, pedicled flap, distant free flap, and anterolateral thigh free flap. Among those surgical techniques, anterolateral thigh free flap provide a thin and pliable flap, which is a useful method for correction of first web space contracture. METHODS: From August 2003 to September 2007, the authors selected 9 patients who had first web space contracture with limitation of thumb abduction within 30 degrees. All of patients had received first web contracture release with anterolateral thigh free flap. Age ranged from 24 to 51, and all the patients were male. Average follow up period was 12 months and the authors performed photographic analysis of the thumb abduction angle of postoperative increase. RESULTS: All the flaps were survived. Donor site was closed with primary closure in 8 cases and covered with split-thickness skin graft in 1 case. Average flap size was 8x9cm and average thickness was 0.6cm in suprafascial flap. The procedure resulted in increased thumb abduction angle of 34.7degrees in average and showed concave shape of first web space in suprafascial flap. Additional operations were performed with Z-plasty in 3 cases, local flap in 5 cases, and opponensplasty in 3 cases. CONCLUSION: In suprafascial flap, we obtained relatively thin flap thickness and were able to make natural concave shape of first web space. In releasing severe contracture of the first web space, anterolateral thigh free flap provided a good coverage of appropriate thickness and pliable soft tissue and allowed limited donor site morbidity.
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Humans , Male , Contracture , Follow-Up Studies , Free Tissue Flaps , Hand , Skin , Surgical Flaps , Thigh , Thumb , Tissue Donors , TransplantsABSTRACT
An interdigital pilonidal sinus is considered a rare occupational disease related to individuals with short hair. We describe a case of a 44-year-old man who presented with a tender nodule with a purulent discharge in the fourth interdigital web space of the left foot. The biopsy specimen showed a sinus tract surrounded by keratin and squamous epithelium, and the track contained acute and chronic inflammatory cells. The skin lesion was improved with occlusion of the fistula by using 100% bichloracetic acid. We herein report on a rare case of a interdigital pilonidal sinus in the foot, and this occurred with no relation to the patietn's occupation.
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Adult , Humans , Biopsy , Epithelium , Fistula , Foot , Hair , Keratins , Occupational Diseases , Occupations , Pilonidal Sinus , Skin , Track and FieldABSTRACT
PURPOSE: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. METHODS: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. RESULTS: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. CONCLUSION: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.
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Humans , Acrocephalosyndactylia , Cicatrix , Contracture , Fingers , Hand , Heart , Joints , Recurrence , Skin , Syndactyly , Tissue Donors , TransplantsABSTRACT
PURPOSE: The key of treatment in syndactyly is to separate the fused digits safely, and to create a normal web space with enough cutaneous coverage. Despite many techniques have described the correction of syndactyly, skin graft still remains the annoying one. We designed the pentagonal flap from hand dorsum to reconstruct the web space reliably and try to minimize the need for skin graft. METHODS: Between July 2003 and August 2005, six cases of syndactyly were corrected at UCLA Medical Center and Hallym University Sacred Heart Hospital using dorsal pentagonal flap for web space reconstruction and straight incisions for the sides of digits to minimize the need for skin graft. The proximal edge of the pentagonal flap was designed in V shape to allow for easy closure of the donor site after advancement. The pentagonal flap was advanced volarly with the underlying dermofat tissues to form a digital web. In some cases, skin defects were unavoidable and covered with full thickness skin graft from the inguinal area. RESULTS: Syndactyly were seen in 4 cases of Apert syndrome, 1 postburn scar webbing with PIP joint contracture and 1 recurrence after the incomplete reconstruction. In all Apert syndrome, straight line incision was used along the sides of the fingers and skin graft was needed. But, in 2 cases of incomplete type, we could save the need for skin graft only for the correction of syndactyly. We could get a good looking web space without any complications such as flap or graft loss. CONCLUSION: As a modification of Sherif's V-Y dorsal metacarpal flap, we believe pentagonal flap could be one of the easiest and safest way to reconstruct the web space of syndactyly in functional and cosmetic standpoint.
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Humans , Acrocephalosyndactylia , Cicatrix , Contracture , Fingers , Hand , Heart , Joints , Recurrence , Skin , Syndactyly , Tissue Donors , TransplantsABSTRACT
Adequate first web space is essential for web space expansion, thumb abduction, and a wide range of thumb mobility and hand function activities. First web space contracture is caused by burns, trauma, infection, arthritis, ischemia, paralysis, spastic conditions, improper splinting, Dupuytren's contracture, or congenital anomaly. We have treated 18 cases of first web space contracture from Nov. 1, 1996 to Apr. 30, 2000 using 23 various flaps. Four measurements such as maximal abduction angle, maximal abduction distance, radial abduction angle, and palmar abduction angle were examined preoperatively and postoperatively. We have classified first web space contracture as mild, moderate, or severe depending upon the magnitude of contracture and scarring of the first web contents (skin, fascia, muscle and joint capsule). We have performed hree Z-plasty, three double opposing Z-plasty, and two 4 flap Z-plasty in 6 mild contracture. We have performed two Z-plasty and F.T.S.G, two dorsal rectangular flap and F.T.S.G, two F.T.S.G, and two S.T.S.G in 5 moderate contracture. We have performed two distant flaps and five free flaps in 7 severe contracture. Periods of follow-up were from 12 months to 35 months with an average of 15 months. Every patient was analyzed by the ratio of postoperative measurements to preoperative measurements. The mean ratios of mild, moderate, and severe contracture were 1.33, 1.28, and 1.38 respectively. Although first web space contracture was severe, its ratio was more improved than that of mild or moderate contracture because of complete release and abundant soft tissue coverage such as first web space free flap. The proper methods of first web space contracture release in accordance with the classification allowed to achieve excellent results.