ABSTRACT
Background: Microsurgical great toe-to-thumb transfer (mGTT) is a widely used procedure when immediate replantation of thumb is not feasible. The aim of this study was to investigate the alteration of plantar pressure profile of the donor foot after mGTT. Methods: Twenty patients receiving microsurgical great toe-to-hand transfer between 1985 to 2014, and 16 healthy subjects were recruited. Group 1 consisted of 20 feet receiving mGTT, whereas group 2 consisted of 32 normal feet as control. The flap design in this study was to preserve 1 cm of the proximal phalanx to maintain the attachment of the plantar aponeurosis and intrinsic muscles. The Taiwan Chinese version of the Foot Function Index was used for patient-reported outcome measurement. A novel Emed-X system was used for dynamic plantar pressure measurement. A total of four parameters were collected, including peak pressure, contact area, contact time, and pressure-time integral. Results: In group 1, the peak pressure redistributed under the first metatarsal bone and was significantly higher than group 2 (P < 0.05). There was no significant change of the contact area between the midfoot region of group 1 and group 2 (P > 0.05). Furthermore, similar foot clearance efficiency was demonstrated in group 1 and group 2 (P > 0.05). Conclusions: The windlass effect of the foot will not be affected when performing mGTT with preservation of 1 cm of the proximal phalanx. Therefore, this surgical procedure is highly recommended for clinical application.
ABSTRACT
Patients with spinal cord injury (SCI) possess higher arterial stiffness index (SI) than the healthy population. This study aimed to clarify the effect of post-morbid duration on arterial stiffening change among SCI sufferers. Seventy-one SCI patients were recruited. The demographic data including age, gender, level of injury, body mass index, American Spinal Cord Injury Association Impairment Scale, and post-morbid duration were collected. The age was 36.4 ± 11.7 years and the duration was 87.5 ± 106.4 months. SI was assessed with digital volume pulse analysis. Correlation matrix demonstrated that age is the most significant determinant of SI (R = 0.503). The scatter plot of duration versus SI showed that they were correlated significantly, but in a logarithmic rather than linear trend. Partial correlation showed that the natural log of duration (Lnduration) has higher adjusted correlation coefficient (0.357) than duration when the effect of age and other factors were eliminated. Multiple linear regression modeling also exhibited that Lnduration is the only factor that significantly increases the explanation of SI by age. In conclusion, Lnduration is an independent determinant of SI. SCI accelerates vascular aging especially in the early several years. Therefore, there should be emphasis on primary prevention of cardiovascular disorders during early years of SCI.
