Abdominal Pocket Method as a Salvage Procedure for Vascular Insufficiency After Distal Digital Replantation.

PURPOSE: To assess the utility of abdominal pocketing of a deepithelialized reattached digit to allow for neovascularization as a salvage procedure for circulatory insufficiency after digital replantation. We performed this method in Tamai zone II cases in which microsurgical vascular anastomosis was expected to be difficult based on the findings at the initial operation. MATERIALS AND METHODS: From 2008 to 2014, 5 injured digits from 5 patients (mean age, 34 years; range: 25-54 years) underwent the abdominal pocket method as a salvage procedure for postoperative circulatory insufficiency. We evaluated the survival incidence, the timing between operations, and the duration of the second operation. During this study period, 7 amputated digits from 7 patients underwent vascular reanastomosis. We also evaluated the survival incidence for these cases. RESULTS: Four out of 5 replanted digital tips survived. The mean time between the initial operation and the onset of vascular problems was 82 hours, and the mean duration of the second operation was 48 minutes. The survival incidence for reanastomosed cases was 6 out of 7. CONCLUSIONS: The abdominal pocket method is useful for treating circulatory insufficiency after digital replantation in Tamai zone II cases in which microsurgical vascular reanastomosis was expected to be difficult based on the findings at the initial operation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Nonincisional osteotomy for gradual lengthening by callus distraction in the hand and foot.

Gradual lengthening by distraction osteogenesis is widely used for brachydactyly. The most frequent postoperative complaint of the patients treated with this method is the appearance of the scar caused by the skin incision for the osteotomy, which is an integral technique of distraction osteogenesis. A nonincisional approach to osteotomy would reduce the dorsal scarring. Gradual lengthening by callus distraction with nonincisional osteotomy was performed in 14 digits. The mean gain in length was 14.3 mm (10-19 mm). Of 14 digits, 13 digits achieved the target length and sufficient bone consolidation and 1 digit showed early consolidation. There was no case in which complications occurred because of the drilling. Nonincisional osteotomy for callus distraction in the hand and foot reduced dorsal longitudinal scarring and achieved good cosmetic results as compared with an ordinary osteotomy involving skin incision.

Arthrodesis of the distal interphalangeal joint using a bioabsorbable rod as an intramedullary nail.

There are several fixation techniques for arthrodesis of the distal interphalangeal joint. Since February 1999 we have used a bioabsorbable (poly-L-lactide, PLLA) rod as an intramedullary nail for arthrodesis of 15 distal interphalangeal joints and one interphalangeal joint of the thumb. The advantages include the absence of protruding hardware that would require removal, and technical simplicity. Preoperative diagnoses included degenerative arthritis in five patients, post-traumatic arthritis in 10 patients, and non-union after arthrodesis with crossed Kirschner wires in one patient. All patients were observed until there was clinical and radiographic evidence of fusion with the mean interval to fusion of 8 weeks (range 6-12). There were two cases of minor intermittent local swelling, which resolved. Fixation with a PLLA rod for arthrodesis of the distal interphalangeal joint is a simple and effective technique.

Osteosynthesis in digital replantation using bioabsorbable rods.

There are several fixation techniques for osteosynthesis in digital replantation. Kirschner wire fixation is used commonly but the wires protrude and disturb mobilization. Moreover, it requires removal. Since February 1995, the authors have been using a bioabsorbable rod made of poly-L-lactide as an intramedullary nail for osteosynthesis in digital replantation. The advantages of this technique include the absence of protruding hardware that would require removal and technical simplicity. This method has been applied for 15 arthrodeses (12 distal interphalangeal joints, 1 proximal interphalangeal joint, and 2 interphalangeal joints of the thumb) and for 11 diaphysis fractures (5 proximal, 5 middle, and 1 distal phalanx). All patients were observed until there was clinical and radiographic evidence of fusion (average interval to fusion, 8.4 wk). Bone resorption occurred in one patient. There were no cases of nonunion or infection. Poly-L-lactide rod fixation is a simple and effective technique.