Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed.@*METHODS@#Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases.@*RESULTS@#All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes.@*CONCLUSION@#The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.

Reconstruction of chronic boutonniere deformity with wide awake local anesthesia and no tourniquet in a patient with upper type brachial plexus injury: A case report

@#Reconstruction of chronic boutonniere deformity remains to be a challenging procedure especially when combined with other debilitating injuries in the same extremity. The balance to properly tension the reconstruction with active motion is often prevented by the need to perform the procedure under sedation of block to tolerate the use of tourniquet. We present a case of a young patient who successfully underwent restoration of active proximal interphalangeal (PIP) extension with a Palmaris longus graft while wide awake under local anesthesia and no tourniquet (WALANT) before subsequently having nerve transfers for upper type brachial plexus injury.

Half hallux toenail flap transplantation to repair the distal segment finger defect / 中华显微外科杂志

Objective To discuss the treatment of half hallux toenail flap transplantation for reconstruction of the distal segment finger defect. Methods Based on using the first plantar/dorsal metatarsal artery, or toe artery as pedicle to cut off partial toenail together with toe abdomen flap or partial toenail to repair 64 cases which include 69 fingers with distal segment complete and partial defect,the distal skin avulsion,skin tube in postoperative plastic,replantation failure and so on.Depending on the size of the donor foot wound use the first dorsal metatarsal artery,second toe artery,the perforating branch of peroneal artery or plantar metatarsal artery flap to cover the wound, and then observe the appearance of the finger and foot donor site after operation. Results The finger pulp was full and elastic,nail bed of the toe was well healing,nail groove which originated from the reconstructed nail fold was shallow,the appearance wos realistic,all feelings were recover,two-point discrimination was 4 to 5 millimeter,the donor toe was plump like the original one in appearance,patients were all satisfied with the reconstructed finger and the toe shape,after a follow-up from 3 month to 4 years. Conclusion Half hallux toenail flap transplantation is an effective way to repair the distal segment finger defect.

Free Flaps for Reconstruction of Soft Tissue Defects Following Crushing Injury to Fingers

PURPOSE: The crushing injury is one of the most severe type injuries in the finger. For the reconstruction of fingers with crushed and devitalized tissue, various surgical methods have been attempted to cover the soft tissue defects. We performed free flaps for finger reconstruction and investigated the results. MATERIALS AND METHODS: Between March 2010 and July 2011, we retrospectively reviewed 14 patients who had soft tissue defects of fingers after severe crushing injuries. There were 8 pulp losses, 4 dorsal skin losses with bony exposure, 1 nail complex loss, and 1 total loss of distal phalanx. In all cases, soft tissue defects in fingers were reconstructed with a free flap. RESULTS: All flaps survived successfully. We could reserve the functional length without additional necrosis and amputation. Reconstructed fingers were returned to normal activity in a short time and the atrophy or deformity was not observed. CONCLUSION: Free flap transfer for the reconstruction of the finger defect after crushing injury is useful for the functional recovery and cosmesis.

Clinical experience of finger reconstruction in child with second toe transplantation / 中华显微外科杂志

Objective To investigate the clinical efficacy of finger reconstruction in child with second toe transplantation,and evaluate the postoperative appearance and function regarding the reconstructed donor feet.Methods From June 2002 to May 2011,sixteen cases were reconstructed in sub-emergency with second toe transplantation.Two thumbs,eight index fingers,and 6 middle fingers were reconstructed.All patients were followed-up from 12 to 24 months.The functions of reconstructed fingers were analysed.Results All the reconstructed fingers survived.Vascular crisis occurred in 1 patient,and survived after re-anastomosis.Necrosis of skin grafts at the domon site with exposed tedons was seen in 1 ease,and healed after changing dressings.All the reconstructed fingers showed good in growth and development,and performed good functions as grabbing,grasping and nipping.Two-point discrimination was between 6 mm and 10 mm.The donor site of the foot had normal gait,without obvious influence on walking.Also,no pain was complained.Conclusion The method of transplanting the second toe can reconstruct the appearance and function of the finger defects in child,and has little effect on the appearance and motion of feet.It is an effective treatment method.

Effecacy analysis on finger reconstruction by transplantation of two second toes / 中华显微外科杂志

Objective To study the clinical application of finger reconstruction by transplantation of two second toes and evaluate the postoperative appearance and function regarding the reconstructed hand and donor feet. Methods Defect of fingers were treated by transplantation and reconstruction with a total of 74 cases,including two second toes transplantation for both thumbs in 2 cases,thumb with index finger in 10 cas es, index finger with middle finger in 8 cases and middle finger with ring finger in 17 cases. Results Sevetythree fingers survived except 1 failed. During the follow up examination made from 3 to 36 months, the reconstructed fingers could move, write and dress with ease, pinch forcefully, show good recovery of manual work and the sensation of pain and warmth. Two-point discrimination found to be between 5 to 10 mm. Both donor feet have symmetrical appearance with normal gait and satisfactory motion. Also, no pain was complained.Conclusion Transplantation of two second toes from both feet is a good method to reconstruct defect of multiple fingers, and has little effect on the appearance and motion of feet.

Finger reconstruction by second toe transfer technique

In the Hospital for Trauma and Orthopedics of Ho Chi Minh city from 1995 to 2004, there were 15 cases (12 male and 3 female) with second toe transfer to replace 8 lost thumbs, 5 lost total long fingers and 2 cases of double toe transfer. Results: All 15 cases had good health and good recovery. The follow-up in 9 patients showed 5 patients in grade 1 recovery and 4 patients in grade 2 recovery according to Pho's evaluation criteria, that means they were useful

The method of tracing the first dorsal metatarsal artery at the layer superficial to the extensor expansion in thumb and finger reconstruction / 中华创伤骨科杂志

Objective To clarify the relationship between the first metatarsal web space and associated vessels and its application in dissection of the toes for thumb and finger reconstruction. Methods The relationships of the first dorsal metatarsal artery to the first deep transverse metatarsal ligament and the extensor expansion were observed on 42 adult cadaver lower limbs. Clinically 36 cases of thumb defects were reconstructed using the method of tracing the first dorsal metatarsal artery around the space of extensor expansion to dissect toes. Results The distal segment of the first dorsal metatarsal artery of Gilbert type I and type Ⅱwas located superficially to the layer of the extensor expansion.The time of harvesting the toe was shortened from 90 minutes to 50 minutes with 100%survival of reconstruction. Conclusions The distal segment of the first dorsal meatarsal artery lies constantly to the superficial layer of the extensor expansion.Consequently the location of the first metatarsal artery of Gilbert type I and type Ⅱbecomes much easier, by adopting the method of combination of sequential dissection and reverse dissection around the space of the extensor expansion.

Cosmetic Reconstruction of Distal Finger with Second Toe-to-Hand Transfer

A series of 17 distal finger reconstructions was successfully performed with second toe-to-finger transfer for the aesthetic purpose. The static 2-point discrimination averaged 9 mm. Total active range of motion was 205 degrees. The mean extension deficit of transferred toe was 10 degrees. Key-pinch and grip power averaged 65% and 90% of the normal opposite site respectively. The subjective satisfaction scores of aesthetic appearance and function on the new reconstructed distal finger by patients' self-assessment were 82 and 78 in average, respectively, over a total score of 100. And, those of foot averaged 88 in function and 77 in aesthetic appearance. For aesthetic refinement in distal finger reconstruction with second toe-to-hand transfer, skeletonization of the neurovascular bundle of the harvested toe as well as intraoperative expansion of the subcutaneous tunneling between skin incisions can avoid unsightly scars on the reconstructed fingers. Defatting of the skin flaps of the amputated fingertip and zigzag incision on the toe flap lead to smooth junction between the amputated digit and the transferred toe. Arterial microanastomosis was done at the interdigital web space to avoid small caliber of the pedicle and cold intolerance. Cosmetic reconstruction of the distal finger with second toe-to-hand transfer leads to high satisfaction of the patients both aesthetically and functionally. This is another new field of cosmetic surgery for the distal finger defects.

Neurovascular Free Toe Pulp Flap Using Dorsal Digital Artery In Finger Reconstruction

Free neurovascular flap transfers have been widely used for restoration of discriminative sensibility and contour of the finger. The free neurovascular flaps from first web space of the foot is a good treatment option to achieve above two conditions. Fingertip reconstruction with a free toe pulp neurovascular flap, since it was described first in 1979, have been reported a lot. But in most cases. toe pulp flap used first dorsal metatarsal artery as a vascular pedicle. The authors, therefore, carried out four dissections on the cadavers to study first web space neurovascular anatomy for using the dorsal digital artery of the foot as a vascular pedicle. On the basis of the results of this cadaver dissection, we reconstructed posttraumatic soft tissue defect of the fingers with first and second toe pulp free flaps in nine patients from February 1999 to April 2000, and obtained adequate functional recovery as well as satisfactory aesthetic appearance. In our case, maximal flap was 2.5 x 2 cm in size, and the dorsal digital artery of the foot, subcutaneous vein and branch of the dorsal deep peroneal nerve were used as a neurovascular pedicle of the flap. All patients gradually recovered a discriminative sensibility, with static two-point discrimination test between 7 and 16mm and a moving two-point discrimination test between 6 and 13mm. The advantages of this free flap from toe(mainly second toe) are minimal donor site morbidity including arterial system, one-stage operation and shorter rehabilitation period. We consider that the free toe pulp flap using dorsal digital artery of the foot is a useful method for reconstruction of small finger soft tissue defect.

Clinical application of dorsal carpometacarpal reversed island flap with dorsal metacarpal nerve to reconstruct finger / 中华显微外科杂志

Objective To investigate the clinical effect of dorsal carpometacarpal reversed island flap with dorsal metacarpal nerve to reconstruct finger. Methods We designed the dorsal reverse carpal and metacarpal island flaps with nerve by using the adjacent two dorsal matacarpal arteries as blood-supply and applied the stand of bone and tendon in waste finger or the free iliac transplantation to reconstruct the every sensory finger. Results Eighten cases were survived completely, and the skin degloving injuries of the finger in 3 cases. The maximum of the flap was 9cm by 8cm. Patients were followed up 3 months to 2 years,7 weeks later pain sense of reconstructed finger was recovered. Sensation over S3 amounts to 89% of the digits. Two-point-discrimination of the digits was 5-10mm. After the operation, the reconstructed finger obtained good appearance, the sensory recovery approach normally. The patients have ability to fulfil daily activities. Conclusion This method has advantages as follow:simple and practical,high survive rate,low impairment,sensible and good appearance.

Finger Reconstruction by Use of the Wrap / 대한정형외과학회잡지

Six thumb reconstructions and one index reconstruction were performed by use of the wrap-around technique. All successful digital reconstructions were reviewed at an average of 37 months after surgery. There were complications related to the digits in three patients ; these included pin site infection (1), malrotation (1), and nail deformity (1). But we considered that function and cosmesis were excellent with a 100% viability rate. All patients regained protective sensation and sttained two-point discrimination (average 10mm). The wrap-around technique represents an esthetically and functionally excellent procedure of digit reconstruction for amputation at the level of metacarpo-phalangeal joint or distal to it.