Finger Reconstruction Research Articles

Clinical outcome contrast of using Hukou artery and ulnar proper digital arteries of index finger translocation to reconstruct artery supply in replanting of rotated and avulsed thumbs

Objective To compare the clinical outcomes of using the Hukou artery and ulnar proper digital artery of index finger translocation to reconstruct artery supply in replanting of rotated and avulsed thumb.Methods From January 2011 to May 2012,replantation surgery were carried out in 16 patients with rotated and avulsed injury of thumb.In group A,all cases were replanted by Hukou artery translocation,in which 6 males and 2 females and (27.0 ±9.5) years old in average.The causes of injury were machine strangulation (7 patients) and traffic accident (1 patient).The average time from injury to operation were(6.1 ± 3.1) hours.The amputed level were at the base of proximal phalanx (5 patients) and metacarpophalangeal joint (3 patients).In group B,all patients were replanted using ulnar proper digital artery of index finger translocation,in which 5 males and 3females and (29.7 ± 13.7) years old in average.The causes of injury were machine strangulation (6 patients) and cord wring injury (2 patient).The average time from injury to operation were(7.1 ±2.2) hours.The amputed level were at the base of proximal phalanx (4 patients) and metacarpophalangeal joint (4 patients).Results The operation time were (3.2 ± 0.8) minutes in group A and (5.3 ± 0.6) minutes in group B.All fingers were survived in both groups.All patients were followed up 3-10 months (6.9 months on average).Excellent rate reached 75.0％ in group A and 75.0％ in group B according to Criterion on Functional evaluation on Finger Reconstruction issued by Chinese society of hand surgery.There were significant differences between the two groups in operation time (P ＜ 0.05),and without differences in excellent rate (P ＞ 0.05).Conclusion There are same outcome by using the Hukou artery and ulnar proper digital artery of index finger to reconstruct artery supply in replantation of rotated and avulsed thumb.However,using the Hukou artery translocation were more simple and minimally invasive. Key words: Thumb; Replantation; Amputation; Reconstructicn; Hukou artery

Reconstructive strategy for primary repair of injuries of the hand and fingers

Objective To explore the strategy and clinical effects of primary reconstruction of severe injuries of the hand and fingers.Methods From July 2006 to May 2012,37 cases with severe injuries of the hand were treated with different microsurgical reconstructive strategies.Three types were identified on account of the severity of the injury.Type A involved multiple finger loss only and was treated with 2 to 4 toes transfer for finger reconstruction (22 cases).Type B involved large area of soft tissue defect only and was repaired by instep island flap and medial plantar island flap transfer (6 cases).Type C involved simultaneous defects of palm of the hand and fingers and required reconstruction using second toe transfer along with instep island flap and medial plantar island flap in 6 cases and reconstruction of palm of the hand with scapular flap and reconstruction of fingers with toe transfers in 3 cases.Results All the transplants in the 37 cases survived.Vascular crisis occurred in 3 cases but was reversed with surgical exploration and intervention.Postoperative follow-up ranged from 8 months to 2 years.The appearance and function of the hands was satisfactory.Comprehensive evaluation based on the extent of the lesions showed an increase of hand function from 35％ to 75％ (average 40％).The surgical reconstruction significantly improved hand function.Conclusion Application of different reconstruction methods based on the severity of hand injuries can achieve successful primary reconstruction the hand and fingers. Key words: Hand injuries; Microsurgery; Repair and reconstruction; Rebuild

Indications for Microsurgical Reconstruction of Congenital Hand Anomalies by Toe-To-Hand Transfers

The indications for microsurgical toe-to-hand transfers in congenital hand surgery have not been defined as clearly as for posttraumatic reconstruction of thumb and finger amputations. The purpose of this study was to develop simple guidelines for referral of children with congenital absent digits for consideration of microsurgical reconstruction with toe-to-hand transfers, based on the morphological or radiographic anatomy of the hand anomaly, not on embryological classifications. From a consecutive series of 204 children referred with congenital absence of the thumb and fingers, 100 toe-to-hand transfers were performed. The indications for microsurgical reconstruction of these children were analyzed retrospectively. Forty-one thumbs were reconstructed in 38 children-15 children with an absent thumb distal to the metacarpal base but with four relatively normal fingers; 12 children with an absent thumb and only one or two digits remaining on the ulnar side of the hand; and 11 children with complete absence of all five digits. Twenty-nine second toes and 12 great toes were transferred to reconstruct congenital absent thumbs. Fifty-nine fingers in 52 children were reconstructed mostly with single second toe transfers-41 children with a thumb but absence of all four fingers and 11 children with absence of all five digits. The morphological or radiographic anatomy of a child's hand with congenital absent digits is a more logical indication for microsurgical reconstruction than any embryological classification. The three most common indications for toe transfers for reconstruction of congenital absent thumbs are (1) absent thumb distal to the carpometacarpal joint with four relatively normal fingers, (2) absent thumb with only one or two fingers remaining on the ulnar border of the hand, and (3) complete absence of the thumb and all four fingers. The two indications for toe transfers for reconstruction of congenital absent fingers are (1) absence of all four fingers but with a normal thumb remaining and (2) complete absence of all five digits.

Commentary on Qi and Chen. Use of twin dorsal middle phalangeal finger flaps for thumb or index finger reconstruction

Commentary on Qi and Chen. Use of twin dorsal middle phalangeal finger flaps for thumb or index finger reconstruction

Free Gracilis Transfer Reinnervated by the Nerve to the Supinator for the Reconstruction of Finger and Thumb Extension in Longstanding C7-T1 Brachial Plexus Root Avulsion

To report the clinical results of a free gracilis muscle transfer to finger and thumb extensors reinnervated by supinator muscle motor branches in patients with longstanding C7-T1 root avulsion. Between January 2010 and January 2011, 3 young adult patients with traumatic C7-T1 brachial plexus palsies had gracilis transfer to the thumb and finger extensors at a mean of 38 months after injury. The muscle flap was connected to radial vessels and comitant veins and to nerve branches supplying the supinator muscle. All patients had recovery of active thumb and finger extension, scoring M3 and M4 on the Medical Research Council scale, respectively, at a mean of 12 months after surgery. Reconstruction of finger and thumb extension in lower-type brachial plexus injuries is a challenging problem that is most commonly addressed with an extensor tenodesis technique, which depends on wrist flexion. Free gracilis transfer innervated by nerve branches to the supinator provided the restoration of thumb and finger extension independent of wrist flexion. For those patients with lower brachial root injury more than a year old, transfer of a free functional gracilis muscle is an alternative for the reconstruction of thumb and finger extension. Therapeutic IV.

Clinical Application and Outcome of the Free Ulnar Artery Perforator Flap for Soft-Tissue Reconstruction of Fingers in Five Patients

Clinical Application and Outcome of the Free Ulnar Artery Perforator Flap for Soft-Tissue Reconstruction of Fingers in Five Patients

A clinical study of degloving injuries in 173 fingers

Objective To compare the clinical results of three different treatments for degloving injuries of the fingers. Methods During January 2002 and October 2008,173 fingers sustained with degloving injurieswere treated.The fingers were treated with one of the three different procedures:replantation (group A),second toe wrap-around flap (group B) and abdominal pedicle flap (group C).The function of the fingers was assessed and the satisfactory rate of three groups was statistically analyzed for all patients. Results Seventy-two of the 79 fingers in group A survived.The overall survival rate was 91.1％.76 of the 79 fingers in group B survived,the overall survival rate being 96.2％.All the fingers treated by abdominal pedicle flap survived.Follow-up period ranged from 3 months to 2 years (average 8 months).According to the evaluation criteria for finger reconstruction issued by the Chinese Hand Surgery Society of Chinese Medical Association,the results were excellent for 64 fingers,good for 6 fingers and fair for 2 fingers in group A,with a satisfactory rate of 97.2％.In group B 62 fingers were rated as excellent,10 as good and 4 as fair,with a satisfactory rate of 94.7％.The success rate in group C was 86.7％,with 7 fingers achieving excellent results,6 fingers good results and 2 fingers fair results.Functional recovery was significantly better in group A and B than in group C,while no difference was found between group A and B. Conclusion Replantation of fingers with degloving injury is feasible and also can restore the function and shape of the fingers if the degloved skin is still intact. Key words: Finger injuries; Replantation; Surgical flaps; Treatment outcome

Reconstruction of Totally Degloved Fingers With a Spiraled Parallelogram Medial Arm Free Flap

To investigate the results of resurfacing completely degloved digits using a parallelogram free flap from the medial arm in a spiral fashion. We reviewed the reconstruction of 26 digits in 21 patients with a parallelogram free flap from the medial arm in a spiral fashion following a non-replantable degloving injury. The sizable perforator was observed consistently in the medial arm with 13 of 21 (62%) originating from the superior ulnar collateral artery, 6 of 21 (29%) directly from the brachial artery, and 2 of 21 (9%) from the superficial brachial artery. All the flaps but one, which sustained partial flap loss, survived uneventfully. Total active motion ranged from 93° to 145° and 112° to 154° in the cases with and without metacarpophalangeal joint involvement, respectively. The static 2-point discrimination test varied from 6 to 13 mm. No scar contracture was recorded in these patients. All the patients were satisfied with the overall results. Resurfacing the defect in a spiral fashion is a valuable and reliable technique for the reconstruction of complete finger degloving injuries. The medial arm flap is a good candidate for this procedure, with satisfactory functional recovery and good aesthetic restoration. Therapeutic IV.

Long-term results of finger reconstruction with microvascular toe transfers after trauma

Long-term results of finger reconstruction with microvascular toe transfers after trauma

Distal Finger Reconstruction Using Free Tissue Transfer from Cosmetic and Functional Points of View

Distal Finger Reconstruction Using Free Tissue Transfer from Cosmetic and Functional Points of View

Donor-site Morbidity after Finger Reconstruction with Wrap-around Flap

Donor-site Morbidity after Finger Reconstruction with Wrap-around Flap

Donor site repair of great toe-nail flap in finger reconstruction surgery

struction surgery Objective To explore methods of donor repair of the great toe-nail flap in finger recon- Methods From December 1998 to December 2010, various kinds of flaps were used in 511 donor sites to repair the great toe-nail flaps, including： 32 dorsal pedal artery flaps; twenty-four first dorsal metatarsal artery flaps; twenty-one second dorsal metatarsal artery flaps; forteen anterior malleolar flaps; seventeen medial tarsal artery flaps; seventy-nine lateral tarsal artery flaps; one hundred and six plantar metatarsal flaps, seventy-nine flaps from second toe; fifteen flaps from mid/lower leg and 124 freed flaps. Results After postoperative 6 months to 11 years of follow-up, repaired donor sites of great toe-flaps all survived successfully, with ideal outlook and function. Conclusion There are many kinds of methods for donor site repair of the great toe-nail flap, and each kind of method has its own advantages and disad- vantages. Among these flaps, plantar pedal artery flap and free groin flap are amony the best ones. Key words: Great toe-nail flap ; Transplantation ; Finger ; Reconstruction ; Microsurgery

Free vascularized metacarpal bone graft combined with extended dorsal metacarpal artery flap for phalangeal bone and soft tissue loss: case report

A 45-year-old man suffered from a complex bone and soft tissue defect of the middle phalanx of his left middle finger after an electric saw injury. Here, we present the patient's clinical and radiological outcomes after reconstruction with a free vascularized metacarpal II bone graft and an extended distally based second dorsal metacarpal artery skin flap (DMCA). To our knowledge, this is the first description of a free vascularized metacarpal bone graft combined with DMCA for distal finger reconstruction.

Toe artery terminal branch island flap for finger reconstruction and remodeling

Objective To study the feasibility of using toe artery terminal branch island flap for remodeling and reconstruction of finger shape. Methods From March 2008 to December 2009,19 fingers of 17 cases that were reconstructed by toe transfer had the toe artery terminal branch island flap inserted in the neck of the second toe during the toe transfer surgery to correct the appearance deficit caused by the narrow area. Results All 19 reconstructed fingers and the inserted toe artery terminal branch island flaps survived after the surgery. Donor site wound had primary healing. Postoperative follow-up lasted 6 to 17 months,with an average of 8 months. The appearance of reconstructed fingers was greatly improved. There was good recovery of pulp sensation,with two-point discrimination being 8 to 12 mm. Patients feel quite satisfied. Conclusion Toe artery terminal branch island flap corrects the deficit in appearance of fingers the palm side of the finger. Key words: Transplantation; Toes; Surgery,plastic; Finger reconstruction

Long-term results of finger reconstruction with microvascular toe transfers after trauma

Amputation of all or most of the fingers severely disturbs the gripping function of the hand. The purpose of this study was to evaluate the long-term functional results of finger-amputation patients rehabilitated with microvascular toe transfers. Fifteen such patients (10 males, median age at injury 26 years (range 5-49 years)) were examined after a median follow-up of 18 years. Eight patients had no fingers spared by the initial trauma and the rest had at least two fingers amputated. The function of the hand was accessed subjectively (questionnaires) and objectively (tests). Further, physical parameters were measured and compared to the other healthy hand. Patients scored consistently well in the test measuring function (the Sollerman hand function test and the modified Tamai score). Activities of daily living presented on average minor difficulties. Patients regained on average 42% of grip and 84% of key pinch strength compared to the other hand. The average movement of the transfer was 28°. One transfer was lost due to inability to restore permanent circulation. In addition, there were one donor and one recipient site superficial infections. We conclude that microvascular toe transfer is a reliable way to improve gripping function after amputation of fingers. Patient approval is generally good and the achieved function satisfactory. Two toe transfers should be considered for patients with no fingers left. Work-related injury may be related to decreased occupational capability.

Presentation, microsurgical therapy, and clinical outcomes in three cases of expanding melanonychia of the nail unit in children

The management of expanding melanonychia in childhood is controversial. Here, we present three cases and discuss their operating indications and reconstruction. Between January 1, 1995 and December 31, 2007, one boy and two girls, were operated for expanding melanonychia, involving the thumb, index finger or the middle finger. They were 2, 4, and 7 years at the time of surgery. A complete resection of the nail plate was performed followed by a direct finger reconstruction using a free short-pedicle vascularized nail flap of the toe. Histology showed a junctional nevus in all cases. The follow-ups were after 2, 3, and 5 years and without any complications or recurrence. Regarding reconstruction, the mean Foucher and Leclère score were, respectively, 17 and 16 points. It is concluded that for expanding melanonychia, in case of doubt, an examination of the entire lesion is necessary. Reconstruction of the nail unit after wide excision with nail plate ablation can be performed using microsurgery as discussed below. However, new guidelines on shave biopsy can make this microsurgical procedure obsolete.

Finger reconstruction: combined flap constituted of bilateral hallux nails, skins and bones

Objective To report our usage of a combined flap which is constituted of bilateral hallux nails, skins, bones to reconstruct a finger, and to introduce the method and outcome of this way. Methods Combine two halves of halluxes harvested from both feet to reform a fabricated finger and then transplant it to the finger stump to reconstruct the defect part of the finger. Plantar flaps or some other flaps near the donor sites were transposed to cover them. From June 2003 to June 2009, a total of 20 fingers (20 cases) which had defect degrees range from I to Ⅲ underwent reconstruction surgeries in this way. Results All the 20 fingers transplanted survived completely. Follow-ups 1 to 5 years after each surgery: all the fabricated fingers had very realistic configurations. The MP joints of the reconstructed thrumbs got to the normal range of motion, and the other reconstructed fingers' total ROM were 203 degree on average. All the reconstructed fingers had the sensation function above S3,and their two-point discriminations ranged from 6mm to 10mm. Both halluxes of each case were conserved major parts of nails and had nice, symmetric appearances. All the flaps for the donor halluxes survived completely, and none of the cases showed pains, ulcers or abrasions of their feet. All the cases showed normal gaits during follow-ups. Conclusion The combined flap by bilateral hallux nails, skins, bones is an ideal alteration for finger defect reconstruction for the important advantages of realistic configuration as well as minor destructions to donor sites. Key words: Finger; Surgical flap; Transplantation; Reconstruction

Repair of tissue defect of the two fingers at the same time with one toe transfer

Objective To investigate the outcome of the finger reconstruction using one toe transfer to repair the tissue defects of two fingers at the same time. Methods Two fingers joint tissue missing and finger defect of 8 fingers in 4 cases were reconstructed with dissociative transplants harvested from two parts of the same toe at the same time.Using the paratelum of the second toes reconstructed the indicis paratelum or finger tip,and using the proximal interphalangeal joint of the second toes repaired the proximal interphalangeal joint's tissue defects of the middle finger at the same time in 2 cases.Using the distal interphalangeal joint and the proximal interphalangeal joint of one second toe reconstructed the proximal interpha langeal joints of the index finger and the middle finger in 1 case.Using the proximal interphalangeal joint and the metatarsophalangeal joint of one second toe reconstructed the metacarpophalangeal joints of the index finger and the middle finger in 1 case. Results All the transplants survived.The patients were followed-up from 2 months to 46 months postoperatively.The function and shape of 2 resconstruction fingers were excellent as assessed with Criterion on Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery.Five resconstruction fingers were good.One resconstruction finger was fire. Conclusion For some appropriate cases with the tissue defects of 2 fingers such as the finger's paratelum,the interphalangeal joint or the metacarpophalangeal joint,this operated technique was a good method. Key words: Toe; Finger; Joint; Transplantation; Microsurgery

Issues in multi-finger reconstruction by toe-to-hand transfer

Objective To study the relevant techniques of multi-finger reconstruction by toe-to-hand transfer and discuss the approaches to achieve better results. Methods A systemic review of 1 597 cases (1 974 fingers) of finger reconstruction by toe-to-hand transfer done during the period of January 1980 to February 2010 in our hospital was carried out. Among these, 354 cases (731 fingers) underwent multi-finger reconstruction (more than two fingers). They were analyzed retrospectively in respects of surgical indication,surgical methods, and postoperative functional recovery in order to seek the patterns and sum up the experience.Results Of the 731 fingers, 725 transplants survived. Only 6 transplants were lost. The survival rate was 99%. Surgical exploration was carried out in 29 cases due to vascular crisis. There were 35 cases that were follow-up for 6 months to 11 years. The appearance and functions of the reconstructed fingers were satisfactory.The patients could return to their jobs and were satisfied with the outcome. Conclusion Multi-finger defect greatly affects the appearance and function of the hand. An appropriate surgical reconstruction strategy should be chosen based on the condition of the hand, patient' s age and demand to restore a near normal hand. Key words: Replantation; Microsurgery; Transplantation

SURGICAL RECONSTRUCTION OF THE FINGERS WITH THE USE OF CONVENTIONAL AND MICROSURGICAL TECHNIQUES

The authors presents a new method of hand and finger reconstruction, which makes it possible to restore finger surface and bony frame by transfer of vascularized osteo-cutaneous grafts on microvessel anastomoses and transposition of the radial flap on peripheral pedicle. Lipocutaneous flaps on temporary pedicles provide coverage for the most part of the reconstructed digit as well as for the present hand defects. Complete acceptance of segments was achieved in 92,8% of cases. In all the cases of successful segment acceptance bony frame stability in the reconstructed digits and restoration of the bilateral hand grip were achieved.