Societies For Surgery Of Hand Research Articles

A study of revascularization in thumb replantation

Objective To provide more references for the thumb revascularization and improve success rate of thumb replantation through retrospecting and summrizing various revascularization methods in thumb replantation. Methods From August 2013 to October 2015, 20 cases of complete or incomplete thumb severance were replanted. There were complete thumb severance in 17 cases and incomplete one in 3 cases. Severance level at distal phalanx was in 4 cases, at interphalangeal joint in 3 cases, at proximal phalanx in 8 cases, at metacarpophalangeal joint in 2 cases, at first metacarpal bone in 3 cases. There were 12 male and 8 female patients, with a mean age of 37.25 years (range, 12 to 64 years). It depended on the injury mechanism and vascular injury condition to choose the revascularization methods. Results Postoperatively all 20 cases completely survived. All the patients were follow-up for 8 to 36 months, with an average of 16 months. The blood supply and appearance of replantation thumb were satisfactory. The finger pulp was full. The function of opposition and pinch were good. According to the functional evaluation criteria of the finger replantation issued by the Hand Surgery Society of the Chinese Medical Association, the results of replantation thumb were excellent in 12 fingers, good in 6 fingers and fair in 2 fingers. Conclusion Fully familiar with the anatomy and variation of thumb blood supply, preoperative complete evaluation of injury mechanism and severance level, and classification can provide more choice for the reconstruction of thumb function. Key words: Replantation; Thumb; Revascularization; Transplantation

Free superficial iliac circumflex artery flap for coverage of dorsal skin defect of the fingers

Objective To evaluate the efficacy of free transfer of superficial iliac circumflex artery flap in covering dorsal soft tissue defects of the thumb and fingers. Methods From September 2010 to October 2015, 21 cases of soft tissue defects in the dorsal aspect of the thumb and fingers were treated with free transfer of the superficial iliac circumflex artery flap. The size of the soft tissue defects ranged from 2.5 cm×3.0 cm to 3.0 cm×5.5 cm. All the cases had different degrees of bone or tendon exposure, with phalangeal fracture in 2 cases and bone and extensor tendon defects in 3 cases. The size of the flaps harvested ranged from 3.0 cm×3.5 cm to 3.5 cm×5.5 cm. The donor sites were closed directly. Results All the flaps survived after the operation. Tension blister occurred in 1 case, and the flap survived after decompression with stitch removal. Primary healing was obtained in the recipient sites and the donor sites in all cases. Secondary de-bulky surgery was performed in 5 cases 3 month after the flap transfer which achieved the good flap appearance. Postoperative follow-up period ranged from 6 to 18 months, the average time being 11 months. All the flaps survived with fine texture, elasticity and aesthetics. According to the functional evaluation standards issued by Hand Surgery Society of the Chinese Medical Association, the results were excellent in 16 cases, good in 4 cases, and fair in 1 case. The two-point discrimination ranged from 8 to 13 mm, with the average being 9 mm. Conclusion Free superficial iliac circumflex artery flap transfer is an effective procedure to repair soft tissue defects on the dorsal side of the thumb and fingers with the excellent function and appearance and minor donor site morbidity. Key words: Finger injuries; Surgical flaps; Superficial iliac circumflex artery; Soft tissue defect

The experience of treating mallet fingers by double locking-loop sutures

Objective To introduce the clinical application and experience of treatment of mallet fingers by locking-loop suture compression technique. Methods From November 2009 to June 2015, 39 cases of mallet fingers were treated with double locking-loop sutures that were crisscross tunneled. The distal interphalangeal (DIP) joint was fixed with Kirschner wire in extension. Tunnels were then made at the base of the distal phalanx to allow passage of 4-0 non-absorbable sutures that wove through the extensor tendon insertion, crisscrossed and tied in a double locking-loop fashion to compress and secure the extensor tendon or the avulsed bone fragments against the insertion. Results All the patients were follow-up postoperatively from 12 to 29 months, with an average of 20 months. Primary wound healing was achieved in all the cases without nail deformation. There were no complications of tendon rupture, adhesion and fracture displacement. Recurrence of mallet deformity was seen in one case which was cured with arthrodesis. According to upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were graded as excellent in 22 cases, good in 16 cases, and fair in 1 case, with a 97.4% excellent and good rate. Conclusion The crisscross tunneled double locking-loop suture is a simple yet reliable technique that allows early functional exercise and leads to good clinical results in treating mallet fingers. Key words: Finger injuries; Treatment outcome; Mallet; Locking-loop

Clinical experience of finger reconstruction with toe transplantation in children

Objective To investigate the feasibility and long-term efficacy of reconstructing thumb and fingers with toe transplantation in children. Methods From June 2005 to December 2015, 11 cases (16 fingers) were reconstructed with toe transplantation. There were 8 thumbs, 6 index fingers, and 2 middle fingers. Results All the reconstructed fingers survived. Necrosis of skin grafts at the donor site was seen in 1 case, but healed after changing dressings. All the patients were followed-up from 1 to 5 years. The growth and development of the reconstructed fingers were satisfactory. The function of grip was regained. Two-point discrimination was 5 to 8 mm. According to the functional assessment criteria for thumb and finger reconstruction issued by the Hand Surgery Society of the Chinese Medical Association, the outcomes were excellent in 8 cases and good in 3 cases. There was no abnormal gait and pain in the donor foot. The function of the foot was not impaired. Conclusion The outcomes of toe transplantation in reconstruction of thumb and finger defects in children were satisfactory. Key words: Toes; Tissue transplantation; Finger defects; Child

Minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the base of the first metacarpal

Objective To investigate the method and clinical outcomes of minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the first metacarpal base. Methods From September 2014 to April 2016, eleven patients with intra-articular fractures of the base of the first metacarpal were treated. All the fractures were preliminarily fixed with Kirschner wire using minimally invasive technique to avoid open reduction. Small incision was made for these that could not be fixed with closed reduction. Then an external fixator was applied to distract the first carpometacarpal joint for 2 to 3 mm and maintain the reduction. The forearm was immobilized with a plaster cast. Results The time of fracture healing was 7 to 9 weeks, the average being 7.6 weeks. The external fixator was removed at 5 to 6 weeks postoperatively when functional exercise was resumed. Postoperative follow-up ranged from 4 to 18 months with an average of 10.5 months. Functions of the involved thumb were evaluated by the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association at final follow-up, which revealed excellent results in 8 cases, good in 2 cases, and fair in 1 case. Conclusion For intra-articular especially comminuted fractures of the base of the first metacarpal, application of external fixator combined with Kirschner wire to fix the fracture and distract the MP joint gives rise to satisfactory results. Key words: Metacarpal bones; External fixators; Intra-articular fracture; Comminuted fracture

Pediatric Hand Surgery in Global Health: The Role for International Outreach.

There is emerging interest in hand surgery and global health. This was emphasized at the 2015 presidential address at the American Society for Surgery of Hand. Children are prioritized because of their increased risk for trauma and higher potential for better outcomes. This study aims to identify how hand surgical volunteer programs can benefit the pediatric hand surgical landscape in global health. There has been no literature review to date. This institutional review board-approved review systematically searched PubMed, Embase, Medline, African Journal Online, and the Journal of Hand Surgery. A scoping review methodology was selected to allow mapping of a body of literature by topic, include a greater range of study designs, and provide a descriptive overview of the reviewed material. All studies published between 2000 to March 2016 relevant to pediatric hand surgery in global health were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to record the search results. Six hundred sixty-eight citations were reviewed, with 10 studies that satisfied the inclusion criteria. Hand trauma (70%), congenital anomalies (30%), tumors (20%), surgical technique (50%), and international outreach recommendation (30%) were common themes. Targeting prevention (50%), international outreach education (30%), and building on previous studies to validate findings study (10%) were identified as gaps.

Management of metacarpophalangeal bone defects after hand trauma by distraction osteogenesis with mini external fixation

Objective To evaluate the outcomes of distraction osteogenesis with mini external fixation in management of metacarpophalangeal bone defects after hand trauma. Methods From June 2010 to December 2015, 16 patients with metacarpophalangeal bone defects after hand trauma received distraction osteogenesis at our department. They were 11 men and 5 women, from 20 to 45 years of age (average, 32.5 years). There were altogether 20 bone defects: 8 cases had single metacarpal bone defect, 2 unilateral second and third metacarpal bone defects and 6 phalangeal shortening after repair of digital stump (involving thumb in 4 cases, index finger in one and index and middle fingers in one). The metacarpophalangeal bone defects averaged 1.8 cm (from 1.0 to 3.1 cm). Under the fluoroscopic guide, 4 or 6 mini half-pins in one line were directly drilled into the dorsal aspect of the involved metacarpophalangeal bone before the Orthofix fixator was mounted. The proximal (18 digits) or distal (2 digits) osteotomy between the second and third pinholes was performed via the dorsal approach. The external fixator and pins were removed without anesthesia after callus maturation. Results Average follow-up period was 12.2 months (range, from 9 to 26 months). All the metacarpal bone defects were reconstructed and all the phalangeal shortenings were lengthened; the bony callus was completely calcified at the lengthened part. The mean lengthening was 1.9 cm (from 1.0 to 3.1 cm); the percentage of lengthening ranged from 26% to 51% (average, 34%). The bone lengthening index (time cost by average 1 cm) was 70.9 d/cm (from 60.0 to 87.1 d/cm). According to the Tentative Assessment Criteria for Upper Extremity Function by Hand Surgery Society, Chinese Medical Association, the total activity of motion (TAM) was excellent in 13 cases, good in 4, fair in 2, and poor in one, yielding an excellent to good rate of 85.0%. Conclusion Distraction lengthening using mini external fixation is a valid option with a minor rate of complications which allows for early functional exercise to help restore the appearance and function of the affected fingers. Key words: Hand; Injury; External fixators; Bone lengthening; Bone defect

Sensate M-shaped digital artery flap for repairing fingertip defect caused by degloving injury in children

Objective To investigate the clinical outcomes of M-shaped digital artery flap with nerve coaptation for treatment of fingertip degloving injury in children. Methods From March 2013 to March 2014, 9 pediatric cases of fingertip degloving injury were treated with M-shaped digital artery flap. The size of the flaps ranged from 3.0 cm×1.0 cm to 3.5 cm×1.2 cm. The dorsal cutaneous nerve inside the flap was coapted to the digital nerve on one side to restore sensation of the fingertip. Results All 9 flaps survived completely. The patients were follow-up for 6 to 14 months. The color, texture and contour of the flaps were good. Two-point discrimination was 6.0 to 9.0 mm on the flap. Joint movement of the fingers was normal. According to the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society, the results were rated as excellent in 7 fingers and good in 2 fingers. No contracture complication occurred at the donor site. Conclusion The surgical procedure of M-shaped digital artery flap transfer is simple. The nerve coaptation makes it a sensate flap. It is an ideal method to treat fingertip degloving injuries. Key words: Finger injuries; Surgical flaps; Child

Clinical efficacy of mini-plate fixation in the treatment of Bennett fractures

Objective To evaluate the clinical outcomes of mini-plate internal fixation for the treatment of Bennett fractures. Methods From May 2009 to May 2014, 20 cases of Bennett fractures were treated with open reduction and internal fixation using a mini plate. Ligament repair was done simultaneously when indicated. Results All the 20 patients were follow-up for 6 to 12 months with an average of 10 months. Loosening of the screw occurred in one case. No other complications such as broken plate, infection or bone nonunion were observed. According to the upper limb functional assessment criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 15 patients, good in 3 patients and fair in 2 patients. Conclusion Open reduction and mini-plate internal fixation is an effective surgical procedure for treating Bennett fractures. It allows early rehabilitation and leads to satisfactory functional outcomes. Key words: Fractures, bone; Internal fixators; Treatment outcome; Mini-plate

Application of regulating pre- and post-load of the blood vessel in small joint transplantation

Objective To explore the clinical application of regulating the pre- and post-load of the blood vessel in small joint transplantation. Methods Four cases of metacarpophalangeal joint defects and 2 cases of proximal interphalangeal joint defects were treated with free transplantation of the second toe metatarsophalangeal joint and proximal interphalangeal joint, respectively. The conventional end-to-end anastomosis of perforators was modified to collateral anastomosis, end-to-side anastomosis, and inset anastomosis. The pressure within the free tissue was balanced by the regulation of the arterial perfusion volume and venous return flow. Results All 6 transplants of small joint free transplantation survived. Tenolysis was done in 3 cases 3 months postoperatively. All the cases were follow-up for 3 to 16 months, the average being 6 months. Range of motion of the metacarpophalangeal joint was 75° to 85°of flexion and -10° to 0° of dorsiflexion: 4.5 points based on the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society. Range of motion of the interphalangeal joint was 65° to 75°of flexion and -15°to 0° of dorsiflexion: 3.1 points. The appearance of the fingers was satisfactory, while the thumb opposition function was good. Conclusion Regulating the pre- and post-load of the blood vessel can improve the survival rate of small joint free transplantation. Key words: Finger joint; Treatment outcome; Pre- and post-load of blood vessels; Toe joint transplantation

Finger pulp reconstruction with innervated reverse digital artery flap through bilateral neurorrhaphy

Objective To investigate the clinical outcomes of finger pulp reconstruction with innervated reverse digital artery flap with the sensory nerve branches through bilateral neurorrhaphy. Methods From April 2014 to March 2015, innervated reverse digital artery flaps with the sensory branches of proper digital nerves were transferred to repair pulp defects of 17 fingers in 15 patients. The flap was designed at the lateral aspect of the proximal phalanx. Two branches of the proper digital nerve that projected towards the flap were included in the flap. After flap inset, these two branches were coapted with the stumps of the bilateral proper digital nerves. Results All the flaps and skin grafts survived uneventfully. These cases were follow-up for 7 to 11 months. The reconstructed pulps had good appearance and supple texture. There was no flap bulkiness or pigmentation. The involved fingers recovered normal active motion. The pain and temperature sensation were recovered in all the flaps. Static two-point discrimination value was 5 to 8 mm, while the average Semmes-Weinstein monofilament score was 3.22 to 3.84. The average Cold Intolerance Severity Score(CISS) was 23 (range, 11 to 44), with 15 patients corresponded to mild cold intolerance and 2 patients corresponded to moderate cold intolerance. According to the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society, the results were rated as excellent in 14 fingers, good in 2 fingers, and fair in 1 finger. Conclusion Satisfactory appearance and sensation of finger pulp can be restored by transferring innervated reverse digital artery island flap with bilateral neurorrhaphy to the branches of the proper digital nerves. Key words: Surgical flaps; Finger injuries; Treatment outcome; Neurorrhaphy

The application of 3D-CTA technology in toe-to-hand transfers

Objective To investigate the clinical significance of the application of 3D-CT angiogram(CTA) in toe-to-hand transplantation for thumb and finger reconstruction. Methods From August 2009 to June 2015, 41 partial thumb and finger defects in 33 cases were treated with toe to hand transfer. Preoperatively both feet were scanned using the 3D-CTA technique to establish three-dimensional images of the vasculature. The courses of the arteries and veins at the donor site and their branching patterns were visualized which allowed harvesting of the donor toe tailored to the number of missing fingers, the length of the defect and the size and shape of the skin defects. Results All 41 toe-to-hand transplants in the 33 cases survived. Postoperative follow-up ranged from 3 months to 1 year. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 17 digits, good in 20 digits, fair in 3 digits and poor in 1 digit.The overall satisfactory rate was 90.2%. The appearance and function of the reconstructed thumb and fingers were satisfactory. Conclusion The 3D-CTA technique can help us formulate individualized and more accurate surgical design in toe-to-hand transfer. It greatly reduces surgical risk and improves the survival rate. It has practical and clinical significance in microsurgical reconstruction of the thumb and fingers. Key words: Fingers; Toes; Repair; Digital technology; Microsurgery

Modified digital artery island flap for coverage of defects of the thumb pulp

Objective To investigate the clinical outcomes of digital artery island flap transfer for coverage of soft tissue defects of the thumbs. Methods From December 2007 to December 2013, 15 cases with soft tissue defects of the thumb were treated with ulnar digital artery island flap from the middle finger or radial digital artery island flap from the ring finger. The digital nerve that accompanies the digital artery was also included in the flap. The flap size ranged from 4.5 cm×3.0 cm to 2.0 cm×1.5 cm. Results All the flaps survived completely. The follow-up period ranged from 4 to 10 months. The functional and cosmetic results were satisfactory. Two-point discrimination was 5 to 7 mm, with an average of 6 mm.According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated excellent in 14 cases and good in 1 case. Conclusion The modified digital artery island flap transfer is ideal for repairing defects of the thumb and restoring sensation. It is simple, safe and reliable. Key words: Finger injuries; Surgical flaps; Digital arteries

Early repair of the re-ruptured digital flexor tenorrhaphy in zones II and III

Objective To evaluate the outcomes of early direct repair of re-ruptured flexor digitorum tendons in Zone Ⅱ and Ⅲ. Methods We retrospectively studied 17 cases(21 digits) of re-rupture of primary flexor tendon repairs in Zones Ⅱ and Ⅲ treated between March 2008 and September 2014. Among them there were 12 males and 5 females with the mean age of 31 years (range, 18 to 42 years). The rupture was in zone Ⅱ in 10 cases and in zone Ⅲ in 7 cases. The interval between the re-operation and rupture was 4 to 17 days (average 8 days). The flexor digitorum profundus tendon was repaired by triple modified Kessler′s technique, and if possible, the flexor digitorum superficialis tendon in zone Ⅲ was repaired by double modified Kessler′s suture. Results The follow-up period ranged from 4 to 8 months, with an average of 6 months. There was no re-rupture of the tendons. According to total active motion (TAM) classification of functional assessment criteria issued by the Chinese Hand Surgery Society, the final results were good to excellent in 85.7% of the digits. Conclusion Early repair of re-ruptured flexor tendons in zone Ⅱ and Ⅲ could still lead to satisfactory results. Key words: Tendon injuries; Treatment outcome; Modified Kessler′s suture; Early repair

Thenar reversed island flap combined with thumb dorsoulnar neurocutaneous vascular flap for repairing of distal thumb degloving injury

Objective To introduce a new surgical procedure for repairing distal thumb degloving injury with thenar reversed island flap in combination with the thumb dorsoulnar neurocutaneous vascular flap and evaluate the clinical outcomes. Methods From March 2010 to June 2012, 12 cases of degloving injury of the distal thumb were treated with combined transfer of thenar reversed island flap and dorsoulnar neurocutaneous vascular flap from the thumb. The thenar reversed island flaps ranged from 2.5 cm×1.0 cm to 4.0 cm×3.0 cm in size and were used to cover volar aspect of the thumb. The dorsoulnar neurocutaneous vascular flaps ranged from 2.0 cm×1.2 cm to 3.5 cm×2.5 cm in size and were transferred to cover the dorsum of the thumb. The donor sites were closed by either direct suture or by full thickness skin graft. Results All the flaps in the 12 cases survived uneventfully. Postoperative follow-up ranged from 6 to 18 months, with an average of 10 months. The appearance, texture and color of the flaps were satisfactory. Sensory and motor function recovery were excellent in 8 cases, good in 3 cases and fair in 1 case according to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association. Two-point discrimination of the thenar reversed island flap on the thumb pulp was 6.9 to 9.5 mm (average 7.8 mm), while that of the dorsoulnar neurocutaneous vascular flap on the dorsum of the thumb was 7.0 to 11.0 mm (average 8.5 mm). According to the British Medical Research Council (BMRC) rating sensory function recovery was S2 to S4, with an average of S3+. Conclusion Combined transfer of thenar reversed island flap and dorsoulnar neurocutaneous vascular flap from the thumb is a surgical procedure that is simple, does not require dissection of deep anatomical structures, preserves known blood vessels, causes minor surgical trauma and leads to satisfactory results in repairing distal thumb degloving injury. Key words: Thumb; Surgical flaps; Microsurgery; Degloving injuries

Repair of fingertip soft tissue defect with the dorsal branches island flaps of the proper palmar digital arteries: a report of 35 cases

Objective To discuss the treatment method and effect of the application of the dorsal branches island flaps of the digital arteries in clinic. Methods During January, 2010 to February, 2015, a total of 20 cases of palmar soft tissue defect of the 2nd-5th distal segments of single fingers were incorporated and repaired by the dorsal branches island flaps of the digital arteries in the base of the distal phalanx. The size of the selected flaps was 3.5 cm × 2.5 cm-2.0 cm × 2.0 cm. In addition, palmar soft tissue defect (n = 15) of the 2nd-5th middle and distal segments of single fingers were repaired by the dorsal branches island flaps of the digital arteries at the 1/3 site of the proximal digital arteries, and the selected flaps size was 4.5 cm × 2.5 cm-3.0 cm × 2.0 cm. Full-thickness skin graft urethroplasty was used in the donor sites. Flap shape, texture, sensory recovery and texture of the skin region, function recovery of the wounded fingers were followed up at 1, 3, and 6 months after operation. Results Thirty-five patients were followed up from 6 to 13 months (average of 7 months). All flaps survived completely in the incorporated 35 cases postoperatively. Flaps had satisfactory appearance, fine texture, and soft texture in the skin transplantation area. The postoperative improvement of sensory function was between S2 and S3, and the two-point discrimination was 10-15 mm. Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 23 cases as excellent, 10 cases as good, and 2 cases as fair. Conclusion The dorsal branches island flaps of the digital arteries are characterized by easy dissection, reliable blood supply, and no major blood vessels needed to be sacrificed, which is an effective procedure for finger soft issue defect repairing. Key words: Proper palmar digital arteries dorsal branches; Fasciocutaneous island flap; Skin defects of the fingers; Repair

Dynamic external traction combined with internal fixation for treatment of comminuted intra-articular fractures of the base of the thumb proximal phalanx

Objective To document the efficacy of our modified dynamic external traction system that is applied concomitantly with internal fixation for comminuted fractures at the base of thumb proximal phalanx. Methods From March 2009 to July 2014, 7 cases of comminuted fractures at the base of thumb proximal phalanx with metacarpophalangeal(MP) joint involvement (AO type C fractures) were treated with open or close reduction and internal fixation. Meanwhile a dynamic external traction system was applied. Postoperative exercise started early.Range of motion of the MP joint, pinch strength and postoperative complications were evaluated. Results Postoperative follow-up period ranged from 13 to 32 months, with an average of 18 months. The mean plaster splint immobilization time was 7.7 days (range, 3 to 14 days). The external fixator was removed at 4.3 weeks on average (range, 4 to 6 weeks). The internal fixation hardware removal time was 7.2 weeks postoperatively on average (range, 6 to 9 weeks). All the patients were able to return to their original jobs. The average active range of motion for the MP joint of the thumb was 8.6° (range, 5° to 10°) extension and 42.4° (range, 35° to 50°) flexion. Mean pinch strength was 89% of that of the contralateral side. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 5 cases and good in 2 cases. Conclusion Dynamic external traction system combined with internal fixation can provide reliable fracture fixation and allow early mobilization of the MP joint. The variable traction force can effectively maintain joint stability during movement and reduce adhesion and contracture of the joint. Key words: Thumb; Finger phalanges; Intra-articular fractures; Dynamic traction

Treatment of hamate hook fractures with rotating compression tension band fixation

Objective To report the experience of treating type Ⅱ and Ⅲ hamate hook fractures with rotating compression tension band fixation. Methods Five patients with type Ⅱ and Ⅲ hamate hook fractures were treated with open reduction and rotating compression tension band fixation from May 2010 to June 2014. Results All 5 patients were follow-up for 14 to 18 months, with an average of 15.6 months. All the patients were satisfied with the treatment outcomes. They recovered near normal range of motion and grip strength, and returned to their original job. According to the wrist function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the average values of active wrist joint motion of the 5 cases were 51° for extension, 55° for flexion, 15° for radial deviation, and 28° for ulnar deviation. Conclusion For patients with type Ⅱ and Ⅲ hamate hook fractures, open reduction and rotating compression tension band fixation is effective and recommended for wide clinical application. Key words: Hamate bone; Fracture fixation, internal; Rotating pressurized; Tension band

Mini perforator propeller flaps for coverage of soft tissue defects of the finger

Objective To discuss the surgical technique and clinical outcomes of digital artery perforator mini propeller flap for soft tissue coverage of finger defects. Methods Soft tissue defects of the fingers in 18 patients were repaired with digital artery perforator mini propeller flap from December 2013 to December 2014. The defects involved the thumb in 8 cases, the index finger in 5 cases, the middle finger in 3 cases, and the ring finger in 2 cases. The size of the defect ranged from 1.5 cm×0.9 cm to 3.5 cm×2.0 cm. Tendon or bone exposure existed in all the cases.The flap size ranged from 2.5 cm×1.1 cm to 5.0 cm×2.5 cm. The donor sites could be closed directly in 8 cases while skin graft was required in 10 cases. Results Flaps in 15 cases survived uneventfully, while those in 3 cases had venous crisis which was resolved by removing some of the stitches. All but 2 patients had 3 to 12 months postoperative follow-up, with an average of 8 months. The flaps had satisfactory appearance and pliable texture. According to the upper limb functional assessment criteria formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 8 cases, good in 6 cases, and fair in 2 cases. Conclusion Digital artery perforator mini propeller flap is a good option for soft tissue coverage of finger defects. The procedure is relatively simple with less damage to the donor site. Aesthetic and functional outcomes are satisfactory. Key words: Hand injuries; Microsurgery; Propeller flaps; Digital artery

Replantation of thumb or fingers with skin degloving injury in 30 patients: an outcomes evaluation

Objective To report the clinical outcomes of replantation of thumb and fingers with skin degloving injuries. Methods Thirty patients with 42 avulsed thumb and fingers treated with replantation from 2007 to 2012 were follow-up for 2 to 7 years (average, 4 years). Based on the level of the degloving injury, avulsion of the index, middle, ring and little fingers was categorized into grade Ⅰ avulsion and grade Ⅱ avulsion. The results of replantation were assessed by the provisional functional assessment criteria for thumb and finger replantation issued by the Hand Surgery Society of Chinese Medical Association and by the Michigan hand outcomes questionnaire (MHQ). Results According to the provisional functional assessment criteria for thumb and finger replantation issued by the Hand Surgery Society of Chinese Medical Association, 93.3% of the cases achieved excellent and good results. This satisfactory rate was 100% in grade Ⅰ avulsions and 87.5% in grade Ⅱ avulsions. MHQ revealed high patient satisfaction. Conclusion Replantation of thumb and fingers with skin degloving injuries can lead to fairly high patient satisfaction with restoration of form and function. Grade Ⅰ avulsions have better results than grade Ⅱ avulsions. Key words: Finger injuries; Replantation; Degloving injury; Follow-up studies