Island nail transfer in the treatment of macrodactyly of the great toe: a case report.

Macrodactyly involving the great toe is difficult to treat when both the functional and cosmetic problems are addressed simultaneously. Partial resection of the distal phalanx is an easy way to reduce the length of the involved toe. However, there are cosmetic concerns with loss of the toenail. The authors report on a clinical case in which shortening and debulking of the toe was performed while preserving the hallux nail. The nail complex was transferred as an island flap to the dorsal aspect of the proximal phalanx. At the 1-year follow-up, the length of the reconstructed toe was significantly decreased, with a normal-looking nail.

PIP reconstruction with vascularized PIP joint from the second toe: minimizing the morbidity with the "dorsal approach and short-pedicle technique".

Toe joint transplantation is a valuable procedure for reconstruction of the PIP joint of the finger. The authors describe recent refinements in the surgical procedure that have permitted them to reduce the morbidity on the donor site and simplify the whole procedure. A single dorsal approach is used at a digital level, allowing exposure of the recipient vessels (palmar collateral artery and superficial dorsal vein) and resection of the joint remnants. The PIP transfer is harvested through a limited dorsal incision, and reconstruction of the donor toe is achieved using a bone graft and a cross-toe flap. An average range of motion of 43 degrees has been achieved in this series with a mean follow-up of 42 months.

Adjacent and spontaneous neurotization after distal digital replantation in children.

In an exclusively pediatric population, this retrospective study examined the functional and aesthetic results after distal replantation without nerve suture. The aim was to demonstrate, in the child, the presence of spontaneous nervous regeneration resulting in a fingertip pulp with discriminatory sensation. Eight amputations in eight children with a mean age of 9 years and 2 months on the day of the accident were reviewed. The cases were managed by a single surgeon over a period of 8 years and were collected from two different hand centers. The patients were then examined by a different surgeon, and the data were collected. Sensibility was evaluated using the Weber, Semmes-Weinstein, and wrinkle tests. The results were excellent, with mean values of 4.6 mm for the Weber test, 3.3 for the Semmes-Weinstein test, and a positive wrinkle test in all subjects. All patients thus recovered discriminatory sensation with minimal aesthetic sequelae. The usual factors adversely affecting the results of the replantation (ischemic time, level and mechanism of the amputation, and quality of the venous return) were examined, but no statistical analysis was performed because of the small sample size. This study demonstrates the presence of the clinical phenomenon of adjacent neurotization in the absence of nerve repair. It thus confirms that children are excellent candidates for replantation of the distal extremities, even when nerve suture is not performed.