Distal finger reconstruction technique combining a distally-based finger flap and a partial toe flap.

BACKGROUND: Although aesthetic reconstruction of an amputated distal finger can be achieved through partial toe transfer, this approach often damages the weight-bearing region of the toe from which the flap is harvested. The purpose of this report is to introduce the minimum invasive surgery technique to reconstruct the distal finger aesthetically without damaging the weight-bearing region of the toe. PATIENTS AND METHODS: Thirty-one amputated fingertips in 30 patients aged 18 to 68 years were treated using this operative technique. Operations were performed between January 2010 and December 2020. All patients were missing the distal finger beyond the PIP joint, and the amputation stump had been covered with healthy skin. A distally based finger flap was elevated at the recipient site, and a slender partial toe flap, including the nail, was harvested from the great toe. These flaps were combined to form the distal finger. In all cases, the weight-bearing region of the toe remained intact. The donor site wound was first closed with artificial dermis, and skin grafting was performed 3 weeks after the surgery. A few patients did not require skin grafting because their wounds epithelized spontaneously. RESULTS: In most patients, the transplanted flap remained healthy and the distal finger was aesthetically restored. Two patients aged over 60 years who were smokers developed necrosis of the transplanted partial toe flap. In all patients, the weight-bearing region of the great toe was intact, and they had no trouble walking during the three-year follow-up period after surgery. CONCLUSION: Our technique, which combines elevation of a distally-based finger flap and transplantation of a partial toe flap, was able to minimize the skin defect area in the great toe. This new distal finger reconstruction technique is minimally invasive and can be used to prevent secondary donor site issues.

A new surgical strategy for reconstruction of claw nail deformity.

Claw nail deformity is common in patients with fingertip injury. The optimal reconstruction remains unclear. We devised a unique strategy for reconstruction of claw nail deformity. We divided the approach into three parts: soft tissue reconstruction, bone graft and nail bed graft. In the soft-tissue reconstruction, a reverse digital arterial finger flap for the finger or an extended palmar flap advancement with V-Y plasty for the thumb was selected. A part of the distal phalanx of the second toe including periosteum was harvested as a bone graft. A nail bed graft from the big toe was performed. We reconstructed in 11 cases of claw nail deformity using our strategy. All cases achieved significant improvement with no recurrence of the claw nail deformity. Moreover, there was no donor site morbidity.

Nasal Dermal Sinus Associated with a Dumbbell-Shaped Dermoid: A Case Report.

Nasal dermal sinus is a rare congenital anomaly. We report a case of the dermal sinus associated with a dumbbell-shaped dermoid and demonstrate the detailed anatomy. The patient was a boy aged 1 year and 4 months with a small pit at his nasion from birth and developed swelling of the forehead. The sagittal view of a T2-weighted image demonstrated a dumbbell-shaped, mixed intense dermoid at the foramen cecum. The sinus tract was depicted as a strand of isointensity between the dermoid and the nasion. Serial sagittal views of T1-weighted images revealed the capsule of the dermoid enhanced with contrast medium, and that the subcutaneous abscess was in continuity with the dermoid. On diffusion-weighted imaging, both the dermoid and subcutaneous abscess were demonstrated as a hyperintensity. Serial sections of the sagittal and coronal computed tomography scans clearly showed an enlarged fonticulus frontalis and foramen cecum remnant and dehiscence of the crista galli. The purulent dermoid cyst including the capsule and the dermal sinus tract were removed completely. We describe our detailed anatomical relationship between the sinus tract with dumbbell-shaped dermoid and the surrounding structures, and emphasize the importance of these anatomy for operation.