Using 320-detector row computed tomography angiography to investigate the arterial anatomy of the toe flaps on living humans.

PURPOSE: Using 320-detector row computed tomography angiography (320-CTA) to investigate the arterial supply for the toe flaps, namely the anatomical characteristics of the dorsalis pedis artery (DPA), the first dorsal metatarsal artery (FDMA), and the arteries of the first toe web space (AsFTWS). METHODS: This was a prospective study on CTA of 72 intact feet of 36 Vietnamese adults who had sequelae of thumb or metacarpal hand amputation, from June 2017 to December 2019, then preoperative CTA images were compared with surgical findings on 31 feet of 29 patients. RESULTS: 320-CTA was able to investigate the DPA, FDMA, and AsFTWS in 100% of cases. DPA was absent in 6.9% of cases. The average diameters at its origin and termination were 3.22 and 2.56 mm, respectively. For FDMA, the rates of Gilbert type I, II, and III were 52.8%, 18.1%, and 29.2%; the average diameters at its origin and termination were 1.98 and 1.67 mm, respectively. At the first toe web space, FDMA was dominant in 54.2% of cases; the first plantar metatarsal artery (FPMA) was dominant in 29.2% of cases; both arteries were equally dominant in 16.6%. The average diameter at the origin of the lateral plantar digital artery of the great toe was 1.48 mm, of the medial plantar digital artery of the second toe was 1.21 mm. Preoperative CTA images resembled the surgical findings in all cases. The survival rate of toe flaps was 100%. CONCLUSION: The 320-CTA provided proper preoperative images in two and three dimensions, and helped surgeons to establish a preoperative surgical plan, thus increasing the success rate of toe transfer surgery.

Use of single-staged transmetatarsal trimmed great toe transfer for reconstruction of a thumb amputation at the carpometacarpal joint.

BACKGROUND: Reconstruction for proximal thumb amputation at the carpometacarpal (CMC) joint level is extremely challenging. All thenar muscles are lost and other fingers might be lost or injured. Transmetatarsal trimmed great toe (TGT) transfer may be an option in such cases. METHODS: Between 2012 and 2018, 11 patients who had amputation of the thumb at the CMC joint level were reconstructed by transmetatarsal TGT transfer in a single stage. There were seven cases in which the right hand was affected and four cases in which the left hand was affected. Three cases involved a contracture scar at the thumb stump and required web space reconstruction. Average follow-up was 33.9 months (range: 12-76 months) RESULTS: All toe transfers survived. The average of static two-point discrimination (S2PD) was 14.6 mm; the average scores of the Quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) were 18.6 and 73.8, respectively. Two cases did not achieve opposition due to mispositioning of the neothumb. In nine cases achieving opposition, the Kapandji score ranged from 4 to 9, pinch ranged from 3 to 11 lbs, and grip ranged from 15 to 86 lbs. In the donor foot, three patients had neuroma and two had a new callus on the palmar side of the second and third metatarsal heads. The average foot and ankle disability index score was 91.6. CONCLUSION: Single-staged transmetatarsal TGT transfer is safe and useful for thumb reconstruction at the CMC joint level. This reconstructive method is suitable for manual workers, especially in the developing countries.

A simple approach to thumb amputation reconstruction at metacarpal base with toe transfer, two case reports.

INTRODUCTION: Reconstruction for thumb amputation at the metacarpal base by toe transfer is challenging. To restore a thumb with normal or near-normal length, the reconstruction plan usually involves a complicated and challenging process either in two stages (stage 1: resolving soft tissue and bone defect; stage 2: toe transfer) or a single stage by using two free flaps (one free soft tissue flap and one toe flap). However, is it necessary to restore the full length of the thumb for functional and aesthetic achievement? PRESENTATION OF CASES: Two male patients (21 and 22 years old) had a thumb amputation at the metacarpal base. We accepted the shortened metacarpal length and performed reconstruction in one stage by trimmed great toe flap, at the level of the metatarsophalangeal joint. The first phalanx of toe flap was fused with the first metacarpal base. On long-term follow-up, both patients were able to return to daily activities, work and had a good cosmesis. DISCUSSION: With our reconstruction technique, two reconstructed thumbs were functionally similar to a thumb amputation group 1 of Campbell-Reid. Using trimmed great toe flap, the tip of our reconstructed thumbs looks like that of a normal thumb. Both patients were satisfied. CONCLUSION: Accepting length shortening, the reconstruction for thumb amputation at the metacarpal base by toe transfer could be done more easily and simply in a single stage.