Clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns / 中华烧伤杂志

Objective: To explore the clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns. Methods: A retrospective observational study was conducted. From May 2018 to April 2021, 12 male patients with thumb destructive defects caused by electrical burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, aged 27 to 58 years, including 10 cases with degree Ⅲ thumb defect and 2 cases with degree Ⅳ thumb defect after thorough debridement. The thumb was reconstructed with free hallux-nail flap combined with composite tissue flap of the second phalangeal bone, joint, and tendon with skin island. The donor site of hallux-nail flap was covered with artificial dermis in the first stage and performed with continuous vacuum sealing drainage, and covered with medium-thickness skin graft from the groin site in the second stage. The donor site in the second toe was filled and fixed with iliac bone strips. The survival of reconstructed thumb was observed 1 week after the reconstruction surgery, the survival of skin graft in the donor site of hallux-nail flap was observed 2 weeks after skin grafting, and the callus formation of the reconstructed thumb phalanx and the second toe of the donor foot was observed by X-ray 6 weeks after the reconstruction surgery. During the follow-up, the shape of reconstructed thumb was observed and the sensory function was evaluated; the function of reconstructed thumb was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; whether the interphalangeal joints of the hallux and the second toe were stiff, the scar hyperplasia of the foot donor site, and whether the walking and standing functions of the donor feet were limited were observed. Results: One week after the reconstruction surgery, all the reconstructed thumbs of the patients survived. Two weeks after skin grafting, the skin grafts in the donor site of hallux-nail flap of 11 patients survived, while the skin graft in the donor site of hallux-nail flap of 1 patient was partially necrotic, which was healed completely after 10 days' dressing change. Six weeks after the reconstruction surgery, callus formation was observed in the reconstructed thumb and the second toe of the donor foot of 10 patients, the Kirschner wires were removed; while callus formation of the reconstructed thumb was poor in 2 patients, and the Kirschner wires were removed after 2 weeks of delay. During the follow-up of 6 to 24 months, the shape of reconstructed thumb was similar to that of the healthy thumb, the discrimination distance between the two points of the reconstructed thumb was 7 to 11 mm, and the functional evaluation results were excellent in 4 cases, good in 6 cases, and fair in 2 cases. The interphalangeal joints of the hallux and the second toe of the donor foot were stiff, mild scar hyperplasia was left in the donor site of foot, and the standing and walking functions of the donor foot were not significantly limited. Conclusions: The application of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns adopts the concept of reconstruction instead of repair to close the wound. It can restore the shape and function of the damaged thumb without causing great damage to the donor foot.

Tenodermodesis para el tratamiento del dedo en martillo tendinoso de presentación tardía en niños y adolescentes / Tenodermodesis for the treatment of late-presenting tendinous mallet finger deformities in children and adolescents

Introducción: El diagnóstico del dedo en martillo tendinoso puede pasar desapercibido inicialmente en niños y adolescentes, esto limita las posibilidades del tratamiento conservador. El objetivo fue evaluar los resultados del tratamiento quirúrgico con la técnica de tenodermodesis en lesiones de presentación tardía.materiales y métodos: Se evaluó retrospectivamente a 9 pacientes (8 niños) con una edad promedio de 8.6 ± 6 años (rango 1-15). Los días promedio de evolución de la lesión eran 27±11.4 (rango 15-45). El mecanismo de lesión fue una herida cortante (4 casos) y un traumatismo indirecto (5 casos). El tratamiento consistió en tenodermodesis e inmovilización transitoria con clavija transarticular. El seguimiento promedio fue de 61 ± 34.7 meses (rango 12-106). Se evaluaron la movilidad activa y pasiva de la articulación interfalángica distal, la presencia de dolor o deformidad, la limitación de actividades de la vida diaria y la necesidad de tratamientos adicionales. Se clasificaron los resultados con los criterios de evaluación de Crawford. Resultados: En 8 pacientes, el resultado fue excelente y, en uno, regular según Crawford. Un paciente poco colaborador requirió una segunda intervención por re-rotura. En dos casos, hubo una complicación (granuloma) y requirió resección. Ningún paciente refirió dolor al final del seguimiento, ni limitaciones para las actividades de la vida diaria. Ocho presentaron extensión activa completa y uno, una deformidad residual de 20°. Conclusión: La tenodermodesis permite la reconstrucción anatómica del mecanismo extensor en niños y adolescentes. Los resultados clínicos de este estudio son alentadores en lesiones no diagnosticadas en forma temprana. Nivel de Evidencia: IV

Introduction: Tendinous mallet finger may go initially unnoticed in children and adolescents, limiting the possibilities of conservative treatment. The aim of this study was to evaluate the outcomes of surgical treatment with the tenodermodesis technique in late-presentig injuries. Materials and Methods: Nine patients (8 males) with an average age of 8.6±6 years (1-15 range) were retrospectively evaluated. The injury manifested at an average of 27±11.4 days after trauma (15-45 range). In 4 patients the mechanism was a laceration and, in 5, indirect trauma. Patients were treated by tenodermodesis and transitory fixation of the distal interphalangeal joint with a Kirschner wire. The average follow-up was 61±34.7 months (12-106 range). Active and passive range of motion of the distal interphalangeal joint (DIPJ), pain, deformity, limitations in everyday life activities, and need for further treatment were evaluated. Crawford criteria was used to evaluate the outcomes. Results: The results were excellent in eight patients, and fair in one according to the Crawford criteria. One case required reintervention for re-rupture in a poorly collaborating patient. Two cases presented granuloma as a complication and required resection. No patients presented pain at the last follow-up, nor limitations in everyday life activities. Eight patients had full active DIPJ extension, and one had a 20° residual deformity. Conclusion: Tenodermodesis allows anatomical reconstruction of the extensor mechanism in pediatric patients. The clinical results are encouraging in late-presenting lesions. Level of Evidence: IV

Melioidosis en Colombia, descripción de un caso clínico y consideraciones epidemiológicas / Melioidosis in Colombia, description of a clinical case and epidemiological considerations

Resumen La melioidosis es una enfermedad infecciosa causada por Burkholderia pseudomallei cuyo diagnóstico clínico puede ser difícil debido a su variada presentación clínica y a las dificultades del diagnóstico microbiológico, por lo cual pueden requerirse técnicas moleculares para su adecuada identificación una vez se sospecha su presencia. Son pocos los antibióticos disponibles para el tratamiento de esta enfermedad y, además, deben usarse durante un tiempo prolongado. Aunque se conoce por ser endémica en Tailandia, Malasia, Singapur, Vietnam y Australia, en Colombia se han reportado algunos pocos casos. Se presenta un caso de melioidosis en la región norte de Colombia, se hace una revisión de las características clínicas y el tratamiento, y se describe la epidemiología local de esta enfermedad.

Abstract Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

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.

A rare anomaly of the foot presented as polydactyly.

Presence of one or more digit is called as polydactyly and may manifest singly or with other genetic disorders. The frequency of polydactyly varies widely among populations. It can occur as an isolated condition or as a feature of a congenital condition. Polydactyly is a rare condition, but still rare is in form of triple great toes. We describe a case in a 4‑year‑old child diagnosed as triphalangism foot with no other obvious visible anomaly. Osteoplasty‑combined surgery, which was ideal for anatomical reconstruction. In a 16‑month follow‑up period child recovered very well.

Plastia de Lapidus en el tratamiento quirúrgico del quinto ortejo supra aducto / Lapidus procedure for treatment of overlapped fifth toe

The varus fifth toe pathology, in spite of its relative frequency and clinical relevance, has been barely studied in relation to the treatment results. 28 overlapped fifth toes operated according to the Lapidus Technique were evaluated retrospectively, corresponding to 17 patients, age average 28 years, opered since year2003. The minimum follow up time was 6 months. The surgical technique consisted on a dorsal approach in "italic s" on the 5° metatarsophalangic joint, capsulotomy and transference of the EDL to the digiti quinti abductor. Preoperative Hallux Metatarsophalangeal-lnterphalangeal AOFAS Scale average was 88,1 and varied to 99,4 points to the six months of pursuit. 100% of the patients showed complete satisfaction with the result. Only 2 patients presented minor postoperative complications (wound infection and dehiscence), which were handled ambulatory. Lapidus Procedure is a safe procedure and effective in the correction of overlapping fifth toe.

La patología del 5° ortejo varo, a pesar de su relativa frecuencia y relevancia clínica ha sido escasamente estudiada en relación a los resultados de tratamiento. Se evaluaron retrospectivamente 28 quintos ortejos supra aducto flexibles operados según la técnica de Lapidus, correspondientes a 17 pacientes, edad promedio 28 años, operados desde el año 2003. El seguimiento mínimo fue de 6 meses. La técnica quirúrgica consistió en abordaje dorsal en "s" itálica sobre la 5° articulación metatarsofalángica, capsulotomía y transferencia del EDL al abductor digiti quinti. El promedio de la Escala AOFAS para antepie preoperatoria fue de 88,1 y varió a 99,4 puntos a los seis meses de seguimiento. 100 por ciento pacientes mostraron satisfacción completa con el resultado. Sólo 2 pacientes presentaron complicaciones menores posoperatorias (infección de la herida y dehiscencia) que se manejaron ambulatoriamente. La plastia de Lapidus es un procedimiento seguro y eficaz en la corrección del quinto ortejo varo flexible.

Atrapamiento de la arteria poplítea: Comunicación de un caso / Popliteal artery entrampment: Report of one case

Popliteal artery entrampment is a rare condition, occurring in young subjects, that causes ischemia of the extremity. The anatomical background is the compression or occlussion of the popliteal artery caused by forced plantar or dorsal flexion. We report a 32 year-old sportsman who presented with gangrene of the right first toe and a history of three months of progressive claudication. The Ankle-Brachial index and pulse volume curve registries showed a severe ischemia below the knee. Angiography showed a medial deviation of the popliteal artery associated to stenosis and aneurysm formation. A CT scan of the contralateral artery was normal. The patient was operated using a posterior approach, performing a reverse saphenous vein bypass graft and excising the popliteal artery. The postoperative period was uneventful.

Análisis clinicopatológico y terapéutico en 30 casos de exostosis subungueal / Clinico pathologic and therapeutic analysis in thirty cases of subungueal exostosis

La exostosis subungueal es un tumor benigno del hueso que se observa con incidencia de 0.003 por ciento en la consulta dermatológica. En la presente comunicación se informa de 30 casos cuyas edades fluctuaron entre los 8 y 60 años de edad, con franco predominio en adolescentes; 17 casos fueron observados en el sexo femenino. Dos casos se observaron en dedos de la mano, tres casos en el tercer dedo del pie y un caso en el cuarto. El resto se localizó en el primer dedo del pie. En casi todos los casos hubo dolor. El diagnóstico se confirmó radiológica e histopatológicamente. El tratamiento fue la excisión quirúrgica de la lesión. Se enfatizan dos puntos en la técnica quirúrgica: conservación de la uña, e incisión paralela a la base de la lesión. Un solo caso tuvo recidiva.

Dedo en martillo: artrodesis de encaje recíproco / Hammertoes: peg and socket arthrodesis

Cuarenta y seis pacientes (71 pies) fueron tratados con una artrodesis interfalángica proximal para el tratamiento de las deformidades rígidas de los dedos en martillo. Un diseño de encaje recíproco fue realizado utilizando fresas con motor eléctrico, combinadas con un tenotomía del flexor largo en el nivel de la articulación interfalángica distal, para evitar la contractura en flexión de esta articulación. No se requirieron fijaciones internas temporarias debido a la utilización de una tenoplastía del extensor, que permite una estabilidad suficiente como para lograr la fusión de dicha artrodesis. La incidencia de la consolidación radiográfica alrededor de la cuarta semana del posoperatorio fue del 95 por ciento. Las complicaciones de esta técnica fueron 3 casos de deformidad residual en angulación del dedo y un caso de fractura del cilindro óseo. Una incompleta remisión del dolor y la restricción prolongada del uso del calzado habitual en el período posoperatorio mediato fueron las causas más comunes de las reservas o insatisfacción del procedimiento

Tratamento cirúrgico dos dedos em garra flexíveis pela técnica de Girdlestone-Parrish / Surgical treatment of fingers in flexible claws by the girdlestone - Parrish technique

Os autores apresentam os resultados obtidos no tratamento da deformidade em garras flexíveis dos dedos dos pés com a técnica da transferência do tendåo flexor longo dos dedos para o aparelho extensor, descrita por Girdlestone-Parrish. Såo analisados os dados de 30 pacientes adultos (180 dedos) seguidos por quatro anos e seis meses em média (mínimo de seis meses e máximo de oito anos e sesi meses). Obtiveram 61,1 por cento de resultados bons e 27,8 por cento de regulares o que confirma a excelência da técnica empregada no tratamento destas deformidades. Os maus resultados concentraram-se no grupo etário acima dos 50 anos o que levou os autores a sugerirem maior atençåo e precocidade no tratamento destas deformidades

Quinto dedo varo supra-aducto / Quintus digitus varusand supraductus

Se realizó un estudio retrospectivo longitudinal de 10 pacientes con quinto dedo varo supraaducto operados con la técnica de Butler en el Hospital ABC de 1979 a 1992, con un total de 16 dedos. Se analizaron los resultados obtenidos comparándose con los resultados en la literatura con la misma técnica y con otras técnicas. Los resultados obtenidos en este trabajo son similares a los reportados en la literatura con un 87.5 por ciento de buenos y 12.5 por ciento de regulares, sin haber obtenido malos resultados. La valoración de resultados se realizó mediante la gradación propuesta por Black en 1985. La deformidad del quinto dedo varo supraaducto requiere tratamiento quirúrgico cuando es sintomática. La técnica de Butler para su corrección es sencilla de realizar y predecible en sus resultados, sin requerir ningún tipo de inmovilización

Desosamiento de los ortejos en la osteomielitis

Presentamos nuestra conducta quirúrgica en la osteomielitis de los ortejos, que consiste en la exéresis de todo el tejido óseo enfermo por un abordaje en "pico de pato", con lo cual hemos obtenido un resultado muy satisfactorio en un alto porcentaje de casos

Enfermedad de ainhum: presentación de 1 caso / Ainhum disease: report of a case

Se presenta un caso de enfermedad de ainhum (dactilolisis espontánea) al que se realiza la desarticulación quirúrgica de ambos quintos dedos de los pies

Skin graft replacement of the nail bed: a radical treatment for onychomycosis of the big toe

Skin graft replacement of the nail bed of the big toe was used in 3 patients with onychogryposis [6 toes] and in 12 patients with onychomycosis [14 toes] with excellent results. The procedure is a simple outpatient one. Symptoms are cured, the cosmetic appearance is satisfactory and prolonged antifungal treatment is not necessary. We strongly recommend this treatment for cases with advanced onychomycosis affecting the big toe in which other methods have failed