Mean Two-point Discrimination Research Articles

Syndactylized glabrous flaps for multiple finger palmar defects.

Palmar finger or pulp defects require coverage with glabrous tissue to achieve a good match with the lost tissue. The management of multiple finger palmar or pulp defects is challenging because these defects may not always be suitable for local or pedicled flaps. In such situations, syndactylizing free or pedicled flaps can be used. We evaluated the results of free glabrous flaps syndactylizing across multiple finger defects. The two flaps used were the superficial branch of the radial artery (SUPBRA) flap and hypothenar free flap. Seven syndactylized glabrous free flaps were used to cover the defects in 16 fingers. The functional results and complaints were also assessed. Mean flap size was 14.35 cm2. Six flaps survived. Postoperative evaluation data were obtained for the 13 fingers. All the patients returned to their previous work. All patients had a diminished protective sensation of at least 4.31 according to the SWM test. The mean two-point discrimination score of the patients was 9.9 mm (7-14). One finger had a PIP joint flexion contracture of 30°, no donor-site complaints were observed. The advantages of these flaps include single operation site, strong glabrous tissue coverage, low risk of flexion contracture, and adequate tissue size for large defects. Disadvantages include two-stage and complex microsurgical operations, prolonged treatment, and hospital stay.

Replantation of digit-tip amputation caused by crush injuries with supermicrosurgery technique.

Digit-tip amputation caused by crush injury is a common emergency scenario, and the management is full of challenges. The objective of this study was to demonstrate the application of the supermicrosurgery technique in replantation procedures for complex digit-tip amputations resulting from crush injuries, while also assessing functional and aesthetic outcomes. We conducted a retrospective analysis of the data from 12 patients who underwent replantation of 15 digits in our department between July 2022 and June 2023. The outcomes of replantation, functional recovery (including return to work, cold tolerance, bone union, DASH score, VAS score, and two-point discrimination test), aesthetic results (including digit appearance, nail deformity, and pulp atrophy), and patient satisfaction were assessed. The amputation of 7 digits occurred within Tamai zone I level, 8 digits within Tamai zone II level, while 4 digits occurred within Ishikawa zone I level, 3 digits within Ishikawa zone II level, 7 digits within Ishikawa zoneIII level, and 1 digit within Ishikawa zone IV level. The replanted digits all survived (100%) without any indications of arterial insufficiency or venous congestion. The follow-up procedures were conducted on all 12 patients, with an average duration of 9.6months (range, 6 to 18months). The fracture successfully underwent healing at 9.2weeks (range, 8 to 13weeks). The mean VAS score was 1.75 points (range 0 to 4 points), the mean two-point discrimination test result was 5.72mm (range 4.0 to 7.0mm), and the mean DASH score was 9.78 points (range 3.33 to 22.5 points). All patients demonstrated cold tolerance and successfully resumed their pre-injury occupational activities. The nail deformity was observed in one digit following replantation within Tamai zone I, and in three digits following replantation within Tamai zone II; moreover, eight digits exhibited varying degrees of pulp atrophy. All patients expressed satisfaction with both functional and aesthetic outcomes. The successful replantation of digit-tip amputation caused by crush injury can be achieved through the application of supermicrosurgery technique, resulting in improved functional and aesthetic outcomes. Digit-tip replantation is a favorable and meaningful procedure with high patient satisfaction.

Reconstruction of Thumb Defects Using the Second Dorsal Metacarpal Artery Flap with Two Pivot Points.

This study aimed to introduce reconstruction of thumb defects using the second dorsal metacarpal artery (DMA) flap with two pivot points. A retrospective study was conducted with 43 patients (group A) who underwent thumb reconstruction using the second DMA flap with two pivot points from July of 2012 to May of 2019. For comparison, the authors reviewed another cohort of 34 patients (group B) undergoing thumb reconstruction using the first DMA flap. Flap sensation and donor-site morbidity were assessed. In group A, the mean two-point discrimination was 8.7 mm (range, 6 to 12 mm) and 9.7 mm (range, 7 to 12 mm) on the innervated and noninnervated flaps at the final follow-up, with a significant difference ( P = 0.012). In group B, the mean two-point discrimination of the flaps was 7.4 mm (range, 6 to 10 mm). By comparison, group B presented better discriminatory sensation than innervated flaps with double pivot points ( P = 0.002). Based on the visual analogue scale score, the mean score of scar pain and appearance of the donor site were 0.1 (range, 0 to 3) and 0.4 (range, 0 to 2) in group A, and 0.5 (range, 0 to 3) and 1.0 (range, 0 to 4) in group B. By comparison, group A presented lower incidence of scar pain ( P = 0.020) and better appearance of the donor site ( P = 0.019). The second DMA flap with two pivot points has a long vascular pedicle, which allows the flap to repair thumb defects. It is associated with low donor-site morbidity but suboptimal sensory recovery. Therapeutic, III.

Modified Bilateral V-Y Rotation Advancement Flap for Coverage of Fingertip Amputations.

Background: The use of homodigital antegrade flow flaps is an appealing option for coverage of fingertip injuries with exposed bone as it provides good padding, sensation and colour match with no need for splinting or secondary procedure for flap separation. V-Y flaps presented by Atasoy and Kutler have limited ability of distal advancement. We used two separate V flaps each based on a separate neuro-vascular bundle to allow better advancement while keeping good vascularity and sensation. Methods: We used a modified bilateral V-Y rotation advancement flap for coverage of fourteen fingertip injuries with bone exposed in 11 adult patients. Time to complete healing and return to work was recorded. Range of motion of injured finger as well as fingertip sensation using two-point discrimination were assessed and compared to non-injured contralateral finger 6 months after surgery. Fingertip hypersensitivity, cold intolerance and hooked nail deformity were assessed as well. Results: All flaps survived, and all patients resumed their activities after a mean period of 5 weeks. The mean two-point discrimination was 3.9 mm and was comparable to non-injured side. All patients regained full range of motion and were satisfied by the result. Two cases suffered from hypersensitivity that resolved at 3 months post-operative. Hooked nail deformity and cold intolerance were not recorded in our study. Conclusions: This modified bilateral V-Y rotation advancement flap technique presents a simple and single step procedure that provides good padding of fingertip with cosmetically pleasant contour and normal sensation. Level of Evidence: Level IV (Therapeutic).

Are cross finger and thenar flaps effective in the treatment of distal finger amputations with the reposition-flap method?

The aim of this study was to evaluate the effectiveness of using cross finger and thenar flaps in treatment of distal fingers amputations with reposition-flap method. Between September 2017 and January 2020, a total of 20 fingers of 19 patients (15 males, 4 females; mean age: 31.6±10.4 years; range, 19 to 52 years) who were treated with repositioning using a cross finger or thenar flap were retrospectively analyzed. Finger length, flap status, pain, cold intolerance, two-point discrimination, bone healing and appearance of the nail were recorded. Functional evaluation was performed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score and range of motion. The mean follow-up was 19.5±5.2 months. A poor result was seen in one patient with the development of necrosis in the flap. With the exception of one finger with necrosis in the flap, no major complications were observed. Union was achieved in all other bones. The mean shortness was 3.7±1.9 mm. The mean Quick-DASH score was 4.5±5.0 and the mean two-point discrimination test was measured as 6.8±0.9. In fingertip amputations repositioning with a cross finger or thenar flap can achieve a near-normal fingertip appearance with the advantages for the surgeon of a short learning curve and no requirement for microsurgery experience. If replantation cannot be applied in fingertip amputations, this method should be considered among the treatment options, particularly for patients with high aesthetic expectations.

Application of groin flap combined with medial plantar artery perforator flap for degree Ⅲ- Ⅳ defects of multiple fingers

To investigate the effectiveness of groin flap combined with medial plantar artery perforator flap (MPAP) for degree Ⅲ-Ⅳ defects of multiple fingers. Between January 2018 and June 2019, 12 patients with degree Ⅲ-Ⅳ defects of multiple fingers caused by crushing were admitted. There were 9 males and 3 females with a median age of 29 years (range, 16-42 years). The mean interval between the injury and admission was 3 hours (range, 1-9 hours). The injured fingers of 7 cases were index and middle fingers, 4 cases were middle and ring fingers, and 1 case was index, middle, and ring fingers. All fingers were taken thorough debridement and covered by the vacuum sealing drainage device during the emergency operation. The mean interval between the debridement and flap repairing was 18 hours (range, 12-36 hours). During the first-stage operation, the iliac bone graft was used to reconstruct bone frame, and the proximal interphalangeal (PIP) joint from the foot was transferred as the digital PIP joint, then the thin groin flap and MPAP were tailored to cover the dorsal and palmar defects, respectively. The size of the groin flap was 7.0 cm×4.5 cm-14.0 cm×9.0 cm, and the size of the MPAP was 8.0 cm×4.5 cm-14.0 cm×6.5 cm. The abdominal donor site was directly sutured, and the foot was repaired with full-thickness skin grafting. The flaps were separated into the finger shape at the second-stage. All the flaps survived, and the wounds healed by first intention; the incisions in the donor site healed by first intention, and the skin grafts survived completely. All patients were followed up 12-18 months (mean, 16 months). At last follow-up, the injured finger was similar to the contralateral one in terms of texture, appearance, and color. The mean two-point discrimination was 8 mm (range, 6-10 mm), and the sensate level recovered to the S 3-S 4. According to the Michigan Hand Outcomes Questionnaire (MHQ), the reconstructed hand function was excellent in 8 cases and good in 4 cases. There was no complication in the donor sites. The degree Ⅲ-Ⅳ defects of multiple fingers were repaired by the groin flap and MPAP, and the reconstructed fingers can perform good texture and motion with being sensate, with less sacrifice on the foot.

Foucher’s Flap For Reconstruction of Thumb Pulp Defects: Evaluation of 14 Cases

Background: Thumb pulp is a common site for hand injuries and the sensory function gained with its reconstruction is very important for hand function. We aimed the focusing in Foucher’s flap of the first dorsal metacarpal artery for coverage of thumb pulp defects. Methods: Our study was done over a period of two years, between 2019 and 2021 and involved 14 consecutive cases of thumb pulp defects treated in our institution. The patients included 12 males and 2 female, mean age of 40,5±14,43 years. Three elective and eleven emergency cases were operated in the study. We observed the patients for a period as following first week, 1 st. Month, 3. Month, 6 and 12 month. Results: The mean used flap was 2,57x2,07 cm. All the patients had good fine touch and the mean two-point discrimination (s2-PD) was 8,9 mm, which was satisfactory. No flap loss occurred in any patient; one patient distal margin necrosis, one patient epidermolysis and one patient venous congestion were observed. Conclusion: Foucher’s flap for thumb pulp defects is successful flap tecnique for sensation reconstruction. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation. Our experience showed that Foucher’s flap is reliable option and has minimal complications.

Application of wrap-around great toe flap combined with medial plantar artery perforator flap for completely degloved fingers

To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap (MPAP) for repairing the completely degloved fingers. Between February 2018 and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted. There were 9 males and 3 females with a median age of 32 years (range, 18-42 years). The injured finger was index finger in 7 cases, middle finger in 3 cases, and ring finger in 2 cases. The skin was avulsed from the metacarpophalangeal joint level, with the intact tendon and joint. The interval between injury and admission was 1-8 hours (mean, 5 hours). All fingers were taken debridement during the emergency operation. The size of the skin defect ranged from 8.0 cm×5.0 cm to 12.0 cm×7.5 cm. After flap thinning, the wrap-around great toe flap (8.0 m×2.0 cm-12.0 cm×3.5 cm) and MPAP (8.0 cm×4.0 cm-12.0 cm×5.5 cm) were used to repair the degloved finger. The donor sites were repaired with the full-thickness skin graft or the flap. All flaps and skin grafts survived completely without significant complications and the wounds at recipient and donor sites healed by first intention. All patients were followed up 12-16 months (mean, 14 months). The texture, appearance, and color of the affected fingers were close to those of normal fingers, and the nails grew normally. At last follow-up, the mean two-point discrimination of the flap was 9 mm (range, 8-10 mm), and the sensation of the injured finger recovered to S3-S4. And 10 cases were rated as excellent and 2 cases as good according to the Michigan Hand Outcomes Questionnaire (MHQ). There was no complication such as pain from walking or skin ulceration at the donor site. The American Orthopaedic Foot and Ankle Society (AOFAS) score was excellent in 9 cases and good in 3 cases. Treating for the completely degloved fingers, the wrap-around great toe flap combined with MPAP can obtain good effectiveness in the respect of the sensation, function, and appearance.

Effect of concentrated growth factor on lower lip hypoesthesia after osseous genioplasty: a prospective, split-mouth, double-blind randomized controlled trial

Lower lip hypoesthesia is the most common complication following osseous genioplasty. Concentrated growth factor (CGF) has recently been shown to improve neural regeneration. The aim of this study was to evaluate the effect of concentrated growth factor on neurosensory recovery after osseous genioplasty. Patients who underwent osseous genioplasty between June 2017 and February 2020 were enrolled. CGF was applied to the mental nerve on one side. The treatment side was randomized, and the other side was considered as the control. Lower lip hypoesthesia was assessed preoperatively and postoperatively (1 week, 1, 3, 6, and 9 months) using the two-point discrimination test and a 10-point visual analogue scale (self-reported paresthesia). The assessor was blinded. Twenty-six female patients completed the study. At 1 and 3 months, both the mean two-point discrimination value and mean visual analogue scale score were significantly lower in the CGF group than in the control group (P < 0.001). At 3 months, the percentage of patients with lower lip hypoesthesia in the CGF group was significantly lower than that in the control group (P < 0.001). Both groups showed resolution of lower lip hypoesthesia at 6 months. Concentrated growth factor may accelerate the recovery of long-standing sensory nerve impairment following mental osteotomy.

Long-term outcome of a “short” anterograde homodigital neurovascular island flap with a simple or double V-Y plasty

IntroductionAnterograde homodigital neurovascular island flaps are very useful for reconstructing proximal fingertip amputations with exposed bone but have the disadvantage of bringing about proximal interphalangeal joint (PIPJ) stiffness. The addition of a single or double V-Y plasty increases mobility without having to extend the dissection beyond the PIPJ. The purpose of this study was to examine the long-term functional outcome of patients who received a “short” anterograde homodigital neurovascular island flap with a single or double V-Y plasty. Our primary hypothesis was that this flap did not induce PIPJ stiffness and our secondary hypothesis was that it preserved good fingertip sensation. Materials and methodsThis was a retrospective study of patients operated between August 2017 and February 2019. The inclusion criteria were the following: a fingertip amputation caused by either a crush or laceration injury with exposed bone, treated during the acute phase of the injury or for secondary necrosis (attempted replantation or subtotal amputation) and classified as type II oblique palmar, type III or type IV amputations according to the Allen classification system. The assessment criteria were: joint mobility, sensory evaluation with the two-point discrimination and Semmes–Weinstein monofilament tests, time to healing, postoperative complications, postoperative splinting, duration of work stoppage, perioperative smoking, cold intolerance, touch hypersensitivity, nail deformity and excluded finger. ResultsNine patients (mean age 53.9 years [32–67]) were operated, of which eight long fingers and one thumb. One procedure was complicated by skin flap necrosis. At the mean follow-up of 22.4 months [16–31], the mean mobility for the metacarpophalangeal joint (MCPJ), proximal interphalangeal joint and distal interphalangeal joint (DIPJ) were 92-0-0°, 97.8-1.5-0° and 60.3-6.8-0°, respectively. In comparison to the contralateral side, a significant difference was only detected in the DIPJs. The mean two-point discrimination in the proximal portion of the flaps were 7.1mm on the ulnar side (p<0.05) and 7.6mm on the radial side (p<0.01), while in the distal portion they were 7.3mm (p<0.01) and 7.8mm (p<0.01). The Semmes–Weinstein monofilament test also detected significantly reduced sensation. ConclusionThe combination of a “short” anterograde homodigital neurovascular island flap with a single or double V-Y plasty seems to avoid PIPJ stiffening while preserving good fingertip sensation. Level of evidenceIV; retrospective study.

İliak Kanat Otogreft Alımında Mozaikplasti Tekniği

INTRODUCTION: The aim of this study to present the results of patients with iliac wing autograft using the mosaicplasty method in order to reduce donor site morbidity and pain, which are two of the most common complications. METHOD: Between 2011-2018, 35 patients (19 men,16 women) who were harvested autograft from the iliac wing were included in the study.The average age of patients was determined to be 42 (10-64) years, the mean follow-up was 39.9 months (12-101). All patients were operated on for pseudoarthrosis surgery.The same orthopedic surgeon harvested all autografts. The patients were evaluated at post-op 15th day, the first month, and the sixth month. Patients were evaluated in their last follow-up (at sixth month) and monofilament test, two-point discrimination test, visual analog scale (VAS), pain duration, numbness, gait problems, major pain area, cosmetic satisfaction were questioned. RESULTS: The mean of the monofilament test was 4.16 (2.83-6.65). The mean two-point discrimination test was 36.5 mm (9-100 mm). The mean VAS was found to be 2.94 (1-4). In the post-op period, the duration of pain was determined as one month in 21 patients, two months in 5 patients, and four months in 2 patients, while seven patients did not complain of pain at all. It was observed that ten patients complained of numbness in the thigh region (28.5%), and 11 patients complained of gait problem and limping (31.4%). Fifteen patients used an assistive walking device after surgery (42.8%). Only two patients complained of pain in the graft area when the major pain region was questioned after surgery (5.7%). Twenty-one patients were found to be cosmetically satisfied (60%) following the surgery scar in the graft region. CONCLUSİON: We believe that iliac autografts taken with the mosaicplasty technique can be used safely in suitable patients with low complication rates and high patient satisfaction

Motor Imagery Performance and Tactile Spatial Acuity: Are They Altered in People with Frozen Shoulder?

Frozen shoulder (adhesive capsulitis) is a severe chronic pain condition that is not well understood and current treatment is suboptimal. In several other chronic pain conditions motor imagery and tactile acuity deficits are present, which are thought to represent associated neuroplastic changes. The aims of this study were to determine if motor imagery performance assessed by the left/right judgement task, and tactile acuity assessed by two-point discrimination, are altered in people with unilateral frozen shoulder. In this cross-sectional, prospective study eighteen adults diagnosed with frozen shoulder in a physiotherapy clinic setting completed a left/right judgement task, response times (RT) and accuracy for the left/right judgement task were determined. Next, tactile acuity over both shoulders was assessed with a novel, force-standardised two-point discrimination test. Results corresponding to the affected side were compared to the pain free shoulder; Left/right judgement task: mean RT (SD) corresponding to the affected shoulder was significantly slower than RT for the healthy shoulder (p = 0.031). There was no side-to-side difference in accuracy (p > 0.05). Neither RT nor accuracy was related to pain/disability scores or duration of symptoms (p > 0.05). Two-point discrimination: mean two-point discrimination threshold of the affected shoulder was significantly larger than the contralateral healthy shoulder (p < 0.001). Two-point discrimination threshold was not related to pain/disability scores or pain duration (p > 0.05); One explanation for these findings is altered sensorimotor processing and/or disrupted sensorimotor cortex representations of the affected shoulder. A case then exists for the use of treatments aimed at reversing these changes, training the brain to reduce chronic shoulder pain.

Pure perforator free sensory proximal ulnar artery perforator flap for resurfacing hand defects.

ObjectiveThis prospective study was performed to investigate the distribution of proximal ulnar artery perforating vessels through three-dimensional blood vessel reconstruction and examine the presence and consistency of the perforating vessels intraoperatively.MethodsFor anatomical guidance, three-dimensional blood vessel reconstruction was performed to determine the consistent presence of perforating vessels in the proximal ulnar artery. A free proximal ulnar artery perforator flap was then transferred in 17 patients to resurface skin defects on the hands. Color Doppler ultrasound was used to identify and mark the perforating vessels. Intraoperative evaluation was conducted to check for anastomosis of the perforating vessels at the marked sites and assess the vessel anastomosis conditions.ResultsNo vascular crisis, flap necrosis, or wound infection occurred after surgery in 15 patients. Postoperative follow-up was conducted for 6 to 36 months. The appearance of the flap was satisfactory, the texture of the flap was soft, sensation was well restored, and hand function was not limited. The mean two-point discrimination of the flap was 7.6 ± 2.2 mm.ConclusionsFree sensory proximal ulnar artery perforator flap transfer is a safe and reliable surgical technique with respect to restoration of both the appearance and sensory function of the hand.

Estimation of Tactile Discriminatory Fitness in Hands of Public Transport Drivers

Background: Public transport drivers are constantly being exposed to stimuli and are at risk of disorder of peripheral nervous system which can be further complicated by comorbidities. Thus, we wanted to examine intactness of tactile discriminatory ability in healthy drivers by comparing it to healthy samples of non-driving population. Since two point discrimination (TPD) test is frequently used for neurological assessment of tactile stimulation we determined and compared various locations in hands of two populations.&#x0D; Methods: Participants were asked to answer whether they feel one point or two points touch by blunted end of simple compass divider in their hand. The minimum distance between the points at which the participants could answer correctly was noted as two point discrimination value.&#x0D; Results: Drivers had TPD range of 2-4mm with mean 2.53±0.62 and, 1-4mm with mean 2.6±0.72 at middle finger of right and left hand respectively. Following t-test between drivers versus students, significant difference in the mean TPD value in the proximal palm supplied by median nerve (p=0.016) and proximal palm corresponding to ulnar nerve (p=0.032) on the right hand was found. On the left hand, significant difference in the mean TPD value is found in the proximal palm corresponding to median nerve (p=0.008) and ulnar nerve (p=0.043) respectively.&#x0D; &#x0D; Conclusion: Healthy public transport drivers have less tactile discriminating prowess at proximal palmar surface of hand. Examined distal phalanges and distal palm showed no significant difference in mean of TPD values for healthy drivers versus students.

Long-Term Outcomes of Digital Nerve Repair Accompanied by Digital Artery Injury in Flexor Zone 2.

Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the “unrepaired artery group” (UA) and 24 patients in the “intact artery group” (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.

Enhancing the Outcome of Traumatic Sensory Nerve Lesions of the Hand by Additional Use of a Chitosan Nerve Tube in Primary Nerve Repair: A Randomized Controlled Bicentric Trial.

Peripheral sensory nerve injuries present a significant yet common challenge in acute hand trauma surgery. Standard treatment remains microsurgical end-to-end nerve repair where appropriate. Permanent loss of sensitivity and painful neuroma formation are typical sequelae of unsuccessful surgery. The objective of this study was to evaluate whether the additional use of a chitosan nerve tube in primary nerve repair positively influences sensory recovery. A randomized, controlled, two-center trial with parallel group design and double-blind assessment was conducted to demonstrate the superiority of the additional use of a chitosan nerve tube compared with microsurgical nerve repair alone. Seventy-four participants were enrolled. The primary outcome parameter used was degree of static two-point discrimination at 6 months after surgery. Additional secondary outcome parameters included filament recognition testing (Semmes-Weinstein); pain; neuroma development; and the Disabilities of the Arm, Shoulder and Hand score. Nerve repair with additional use of chitosan nerve tubes (intervention group) significantly increased both tactile gnosis (expressed by two-point discrimination) and sensitivity (expressed by Semmes-Weinstein testing). The mean two-point discrimination at 6-month follow-up was 8 mm (range, 2 to 20 mm) in the control group and 6.3 mm (range, 1 to 15 mm) in the intervention group, respectively (p = 0.029). Two-point discrimination correlated with the Disabilities of the Arm, Shoulder and Hand score. In the control and intervention groups, respectively, three versus zero neuromas were found. Peripheral sensory nerve regeneration can be improved significantly by additional use of a chitosan nerve tube. An improved ability of static two-point discrimination is clinically relevant. Therapeutic, I.

Clinical effect observation of vascularized anterior transposition of ulnar nerve for treatment of severe cubital tunnel syndrome

Objective To evaluate the clinical outcomes of a modified procedure of ulnar nerve anterior transposition in the treatment of severe cubital tunnel syndrome. Methods From September 2015 to May 2016, 25 patients with cubital tunnel syndrome underwent vascularized ulnar nerve anterior transposition were followed up after operation. All the patients had severe muscular atrophy and deformity of elbow joint before operation. According to Gu Yudong's classification of cubital tunnel syndrome, they were graded as severe. In this modified procedure, the sufficient neurolysis of ulnar nerve as well as the anterior transposition of ulnar nerve accompanied with superior ulnar collateral artery were conducted. Results All the 25 patients were follow-up from 12 to 21 months with an average of 15.3 months. All the patients achieved sensory recovery in different degrees without temporary worsening of clinical symptoms. Completely sensory recovery was observed in 20 patients (80%). 4 patients (16%) remained occasional sensory symptoms while only 1 patient (4%) remained persistently moderate sensory symptoms. The mean two-point discrimination of little finger pulp was improved from preoperative 6.08 mm to postoperative 2.93 mm. Obvious improvement of intrinsic muscular atrophy was observed in 17 patients (68%). According to the Gu Yudong's function evaluation standard of cubital tunnel syndrome, the results were excellent in 16 patients, good in 6 patients and fair in 3 patients with the excellent and good rate being 88%. Conclusion The modified technique of vascularized anterior transposition of unlar nerve appears to be an effective and safe procedure for the treatment of severe cubital tunnel syndrome. It might reduce the incidence of postoperative nerve symptoms caused by devascularization of ulnar nerve. Key words: Cubital tunnel syndrome; Ulnar nerve; Vascularized; Anterior transposition

Cross finger flap cover for fingertip injuries

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Fingertip injuries are the most common form of hand injuries. Restoration of the anatomy is a technical challenge and is one of the basic tenets of the management of fingertip injuries. The cross finger flap is simple and easy to do and is a very useful tool in reconstruction of the pulp of the finger. The project aimed to study the efficacy of cross finger flap in the coverage of fingertip injuries.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The study was conducted on a prospective basis in Sri Ramachandra University Hospital in Chennai. The study period was from May 2013 to August 2016. All adults who had fingertip injuries who had undergone cross finger flap cover were included in the study. Patients who had other flaps for reconstruction and who were lost for follow-up were excluded from the study. Preoperative parameters which were recorded were mechanism of injury, size of defect, size of the flap, location of donor site and method of coverage of secondary defect. Outcome measures recorded were flap viability, flap sensibility using two-point discrimination, range of motion of fingers, grip strength and presence of other complications&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;40 patients were included in the study. Six were lost for follow-up. Mean follow-up was 14 months. All flaps survived. Full range of motion was obtained in 87% of patients. Average grip strength was 94% for dominant hand injuries and 78% for non-dominant hand injuries. Mean quick DASH score was 10.5. Mean two-point discrimination was 15.4 mm. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Cross finger flap is very effective for coverage of volar fingertip defects with minimal residual problems.&lt;/span&gt;&lt;/p&gt;

Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?

Introduction: The purpose of this study was to comparatively evaluate the clinical outcomes of open carpal tunnel release with or without flexor tenosynovectomy and epineurectomy for the treatment of idiopathic carpal tunnel syndrome. Methods: In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel’s signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed. Results: The increase in the grip strength and Quick Disability of Arm Shoulder Hand Questionnaire score were significantly better in flexor tenosynovectomy and microsurgical epineurectomy group. The average pre-operative two-point discrimination was 6.3 ± 2 mm in Group-1 and 5.8 ± 1.7 mm in Group-2. Post-operatively at the end of 12 months, the mean two-point discrimination was measured as 5.9 ± 1.6 mm in Group-1 and 5.6 ± 1.3 mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly. Conclusion: We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.

RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP

To investigate the effectiveness of free second toe dorsal flap combined with middle or ring finger island flap for repairing degloved thumbs. Between August 2009 and June 2013, 6 patients with degloving injury of the thumb were treated using free second toe dorsal flap combined with middle or ring finger island flap. There were 4 males and 2 females, aged 19-44 years (mean, 32 years). The left thumb was involved in 2 cases and the right thumb in 4 cases, including 5 cases of type II and 1 case of type III degloving injury. The size of wound was 5.5 cm×2.5 cm to 6.5 cm×5.0 cm. After emergency debridemented, 5 patients underwent vacuum sealing drainage and surgical repair after 3-5 days; 1 patient underwent abdominal embedding and repair after 14 days. The size of second toe dorsal flap ranged from 2.5 cm×2.2 cm to 4.2 cm×3.0 cm, and the size of middle or ring finger island flap ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm. Neurorrhaphy was performed between the plantar digital nerve of the second toe and the proper digital nerve at the recipient site in 5 cases, and no nerve anastomose in 1 case. All the distal phalanxes were partially excised. The donor sites were covered with free skin grafts. All of the flaps survived completely and incision healed by first intention. Three patients had alloesthesia of the middle or ring finger island flaps. All of the 6 patients were followed up from 6 months to 3 years (mean, 23 months). The flaps had good color and soft texture, and the finger had satisfactory appearance, but the fingernails were smaller than that of normal side. The sensation of the dorsum of the second toe reached S3, and the mean two-point discrimination of the pulp was 6 mm (range, 4-7 mm). According to total active movement (TAM) system, the function of the thumbs was excellent in 5 cases and good in 1 case. A combination of free second toe dorsal flap and middle or ring finger island flap is a useful and reliable technique for reconstruction of a degloved thumb.