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.

Rotura traumática del extensor propio del hallux en la inserción distal: Reporte de un caso / Traumatic rupture of the extensor hallucis longus at the level of the distal insertion. Case report

Las roturas del extensor propio del hallux son poco frecuentes, más aún aquellas espontáneas o por traumas indirectos. Se pueden producir en cualquier parte del recorrido del tendón, pero las lesiones más frecuentes son las secciones tendinosas por heridas cortantes. No existe una técnica quirúrgica específica descrita para la reinserción distal del tendón. El objetivo de este artículo es presentar a un paciente de 35 años que, por un traumatismo indirecto, sufrió la rotura del extensor propio del hallux a nivel de la inserción distal. Se describen la técnica quirúrgica, la rehabilitación y los resultados según el puntaje de la AOFAS preoperatorio y posoperatorio. Nivel de Evidencia: IV

Extensor hallucis longus ruptures are infrequent, mainly those due to spontaneous or indirect traumas. Ruptures can occur anywhere along the tendon course, but the most frequent injuries are tendinous sections due to sharp wounds. There is no specific surgical technique described for distal reinsertion of the tendon. The objective of this paper is to present a 35-year-old patient who suffered an indirect trauma in forefoot, causing the rupture of extensor hallucis longus at the level of the distal insertion. Surgical technique, rehabilitation program, and results according to the pre- and post-surgery AOFAS score are described. Level of Evidence: IV

Bob marley's disease: cerebral metastasis of acral melanoma / A doença de Bob Marley: metástases cerebrais de melanoma acral

Bob Marley's had a great importance to Jamaica, Caribbean popular music, and Pan-Africanism. Under the name of the Wailers, several Marley's success reggae albums were recorded between 1969 and 1975. After this, at the solo career, he was placed as the most important reggae singer. The disease that ruined Bob Marley was an acral melanoma (right hallux) that had a late diagnosis and treatment, followed by metastases to the abdomen, the lungs and the brain. Seizures have been the warning sign that the melanoma had spread, three years after the initial injury. We presented here the history of the disease of this famous singer and reported another patient with a case quite similar to him, calling his illness as "Bob Marley's disease".

Bob Marley representou um marco para a Jamaica, para a música popular do Caribe, e para o Pan-Africanismo. Com o nome de Wailers, vários álbuns de reggae foram gravados com sucesso entre 1969 e 1975. Em sua carreira solo, ele foi considerado o mais importante cantor de reggae. A doença que dizimou Bob Marley foi um melanoma acral (hálux direito) que teve um diagnóstico e tratamento tardios, seguido de metástases para o abdome, pulmões e encéfalo. Crises convulsivas foram o sinal de alerta, três anos após a lesão inicial, de que o melanoma estava disseminado. Nós apresentamos aqui a história da doença deste famoso cantor e relatamos um outro paciente com um caso similar ao qual denominamos "doença de Bob Marley".

Hallux amputation after a freshwater stingray injury in the Brazilian Amazon

Abstract: Freshwater stingray injuries are a common problem in the Brazilian Amazon, affecting mostly riverine and indigenous populations. These injuries cause severe local and regional pain, swelling and erythema, as well as complications, such as local necrosis and bacterial infection. Herein, we report a case of bacterial infection and hallux necrosis, after a freshwater stingray injury in the Brazilian Amazon, which eventually required amputation. Different antimicrobial regimens were administered at different stages of the disease; however, avoiding amputation through effective treatment was not achieved.

Onicocriptosis del hallux: analisis comparativo entre la tecnica de preservacion de la matriz y la tecnica con lesion de la matriz ungular / Onychocryptosis on the hallux: comparison between matrix preserving and ungueal matrix excision techniques

Introduccion: La onicocriptosis es una patología de observación común en la especialidad. Se describieron múltiples tratamientos, con resultados variados, según consta en la bibliografía. El objetivo del presente estudio es comparar los resultados clínicos-funcionales de los pacientes tratados por onicocriptosis mediante dos técnicas diferentes: con conservación de la matriz ungular y con lesión de la matriz ungular. Materiales y métodos: Entre marzo de 2002 y octubre de 2006 se evaluaron dos grupos de pacientes tratados quirúrgicamente por onicocriptosis: grupo A sin lesión dela matriz (54 casos) y grupo B con lesión de la matriz (33 casos). La edad promedio de ambos grupos fue de 35 años. Se analizó la evolución clínica, la comodidad con el resultado estético y con el calzado, y las complicaciones y recidivas. El seguimiento promedio fue de 19 meses en el grupo A y de 24 meses en el grupo B. Se utilizó el método estadístico para comparar ambos grupos. Resultados: Recidiva: grupo A 11 por ciento y grupo B 6 por ciento. En cuanto al dolor posoperatorio, ambos grupos presentaron, según la escala visual, menos de 0,5/10 de dolor. En el grupo A, el 16,6 por ciento presentó dolor leve y en el grupo B lo presentó el 3 por ciento. Estética: satisfacción del 100 por ciento en ambos grupos. Conclusiones: El tratamiento de onicectomía sin lesión de la matriz estaría indicado en los casos primarios. En el caso de recidiva indicamos la cirugía con lesión parcial de la matriz (borde comprometido), ya que presenta menor tasa de recidiva.

Manejo quirúrgico de las onicocriptosis asociadas a grandes granulomas, con Resección lateral en ôvõ / Surgical management of the onicocriptosis associated to big granulomas, with lateral resection in ôvõ

La onicocriptosis o uña encarnada es una afección muy frecuente que por lo general compromete el dedo mayor del pie y en menor porcentaje otros dedos. Se caracteriza por la presencia de inflamación, exudación, edema y formación de distintos grados de granulomas reactivos en el dedo afectado, debido a la incrustación de un segmento de uña en el surco lateral ungueal, que además origina dolor, infección y molestias al caminar. Presentando un caso clínico como ejemplo, se describe una nueva variante de técnica quirúrgica para el tratamiento de las onicocriptosis asociadas a granulomas hipertróficos, que consiste en la resección lateral del borde ungueal comprometido, matricectomía parcial y resección en V de la cara lateral del dedo donde asienta el granuloma. El objetivo de esta presentación es dar a conocer esta alternativa de tratamiento quirúrgico, con la cual se consiguen excelentes resultados anatómicos y estéticos, prácticamente sin recurrencia en los casos tratados.

The onicocriptosis or ingrown toenail is a very common disease that usually affects the big toe and in minor proportion other toes. It is characterized by the presence of inflammation, exudation, oedema and formation of reactive granulomas of varying degrees in the affected toe, due to the embedding of a segment of nail in the lateral groove of nail; also causes pain, infection and discomfort when walking. With the presentation of a tipical case is made the description of a new variant of the surgical technique for the treatment of onicocriptosis associated with hypertrophic granulomas which involves the resection of the committed lateral edge nail, matricectomy, resection V side of the toe side where granuloma is localized. The objective of this presentation is to present this alternative of surgical treatment, which achieved excellent anatomical and aesthetic results, with virtually no recurrence in the cases treated.

Artrodesis metatarsofalángica del hallux mediante fresado motorizado en cono truncado / Arthrodesis of the hallux utilizing truncated cone reaming technique

Presentamos nuestra experiencia sobre artrodesis metatarsofalángica del hallux utilizando fresado motorizado en cono truncado. Se revisaron los resultados clínicos y radiológicos de 43 pies en 33 pacientes operados por el mismo cirujano. El seguimiento promedio fue 31,2 meses (rango, 13-48). Para evaluar la eficacia de esta técnica, hemos centrado nuestra atención en el índice de consolidación, en el acortamiento del primer rayo y en la repercusión sobre la articulación interfalángica del hallux (puntuación de Fitzgerald). El tiempo promedio para lograr la consolidación fue 11,2 semanas (rango, 8-12). El porcentaje de consolidación fue 95,3% (41 pies). En 2 pies (4,7%) no hubo consolidación: uno desarrolló una seudoartrosis sintomática y otro una unión fibrosa asintomática y funcionalmente útil. El acortamiento del primer rayo fue de 6,4 mm (rango, 2-10). En la fecha de último seguimiento, 3 pies (3,9%) progresaron a puntuación 4 de Fitzgerald. No se registraron infecciones. El fresado en cono truncado ha probado ser un método eficaz para lograr la artrodesis metatarsofalángica en variadas patologías que afectan esa articulación; y se asocia con un bajo índice de complicaciones y seudoartrosis. Se discuten los resultados y se efectúa una revisión de la literatura

Hallux rigidus: resección artroplástica metatarsofalángica

La función normal de la primera articulación metatarsofalángica depende no sólo de aspectos inherentes a la propia articulación, sino también de la movilidad sesamoidea y de la capacidad del primer metatarsiano para la flexión plantar. Microtraumatismos agudos o crónicos pueden dañar la superficie articular cuando la flexión plantar del primer metatarsiano se encuentra limitada por un metatarsiano hipermóvil o un metatarsiano de excesiva longitud o un metatarsus primus elevatus. Clasificamos a los hallux rigidus según Regnauld y consideramos las conductas terapéuticas en los distintos estadios, analizando en particular nuestra experiencia con la técnica de Valente Valenti o artrectomía en bisagra, que venimos efectuando desde hace más de 10 años. Analizamos resultados y complicaciones

Hallux varus: tratamento cirúrgico pela transferência do hemitendäo extensor do 2o. artelho e osteotomia da falange proximal do hálux / Hallux varus: surgical treatment through transfer of the 2nd toe hemitendon extensor and osteotomy of the hallux proximal phalanx

Os autores apresentam a classificaçäo do "hallux varus" com revisäo da literatura. Sugerem técnica cirúrgica para os casos de "hallux varus" adquiridos, pela transferência do hemitendäo extensor do 2§ artelho e osteotomia valgizante da falange proximal do hálux. Säo relatados cinco casos.

Tratamento cirúrgico das fraturas articulares do hálux / Surgical treatment of raticular hallux fractures

As fraturas articulares do halux sao pouco freqüentes e a literatura pobre quanto ao seu tratamento. Apresentamos neste trabalho quatro fraturas articulares desse segmento do esqueleto e o tratamento realizado. Conseguiu-se, através da osteossíntese com material AO de minifragmentos, boa reduçao e recuperaçao funcional.

Metatarsal osteotomy for the treatment of hallux valgus

One hundred feet in 85 patients operated upon for correction of symptomatic hallux valgus deformity. The age of patients ranged from 14 to 60 years. Seventy patients had unilateral operation while 15 patients had been operated upon bilaterally. Forty-four patients were females and 41 were males. Distal metatarsal osteotomies. Mitchell, modified Hohmann, and chevron techniques were performed as well as Wilson oblique osteotomy. The results were rated excellent and good in 84.4% in Wilson group, 62.4% in Mitchell group, 64.7% in modified Hohmann group and 50% in chevron group. The Wilson oblique osteotomy is technically uncomplicated and yields a high percentage of satisfactory results. Modified Hohmann and the Mitchell osteotomies inspite of their technical demand had been found relatively simple and the results were uniformly good. The three osteotomies were found to be the proven methods of surgery recommended in adolescent and young adults and even older patients provided that there are no degenerative changes. Chevron osteotomy inspite of being straightforward and simple procedure, yet it is recommended in the treatment of patients who have limited degree of deformity

Reimplante do hálux / Replantation of the hallux

Os autores apresentam caso de reimplante em amputaçäo de hálux. Com base no papel que desempenha na biomecânica normal do pé e sua influência na marcha, sugerem que sempre que possível deva ser tentado o reimplante nas amputaçöes de hálux