Static Two-point Discrimination Test Research Articles

TRANSMETACARPAL REPLANTATION. ELEVEN YEARS LATER

A case in a series of nine transmetacarpal replantations was presented at the combined meeting of the 7th European congress on Prevention of Hand Traumas and the 7th congress of the Bulgarian Society for Surgery of the Hand, 19-21 October 2023, Plovdiv, Bulgaria.
 A male patient aged 42, a heavy truck driver, was an ideal candidate for replantation. In February 2012 he sustained transmetacarpal amputation by circular saw through the proximal third of the left hand, with local crush of the tissues. During replantation enormous tissue edema appeared, caused by long ischemia time with cryopreservation of the amputated part for three hours. Restoration of the common digital nerves was postponed and performed 4 months later (Millesi procedure).
 Eleven years later the following outcome is registered. TAM: 110 (good), ab-adduction of 2nd and 4th fingers is restored in limited range. The effect is attributed to reinnervation of some spared interosseous muscles by the motor branch of the ulnar nerve, restored during the autoplastic of the common digital nerves. The lateral pinch between the thumb and second finger is useful.
 The skin sensitivity is examined by Weber static two-point discrimination test (2pdt):12 mm for 2nd and 3rd fingers, 15 mm for the 4th finger and one point for the pulps of the 5th finger and the thumb; 2pdt, carried out on the palm, in the base of the fingers, is 10 mm.
 The gained useful function of the hand is 50%. Original working ability is restored, but it is forbidden for the patient to work as a professional driver. He can drive his own car.
 In transmetacarpal replantations with level through the proximal part of the palm some interosseous muscles are preserved, and repair of the motor branch of the ulnar nerve is with favorable prognosis regarding functional recovery.

V advancement eversion flap for fingertip injury: Preventing ischemia and hook-nail deformity

IntroductionTraumatic fingertip amputation is the most common type of upper extremity injuries. The V-Y advancement flap is a reliable method for reconstructing fingertip defects, but it is associated with complications such as hook-nail deformity and suture site ischemia. Here, we describe our modifications to V-Y advancement flap technique, termed as “V advancement eversion flap” and review the outcomes of this procedure in 21 patients with fingertip amputation. MethodsThis was a retrospective review of 21 consecutive patients with fingertip injury who were treated surgically using the V advancement eversion flap technique at a single trauma center between 2006 and 2019. We analyzed the age, injury location and mechanism, Allen classification, injury geometry, and objective and subjective clinical outcomes. ResultsTwenty-three fingertip amputations with defect sizes greater than 1.0 cm2 from the tip to lunula were included in this study. The mean age of the patients was 43.6 years (range, 24–65 years). The average follow-up period was 20 months (range, 12–37 months). The average wound healing time (apparent epithelization) was 29.4 days (range, 14-41 days). At the final follow-up, all flaps had healed uneventfully without noticeable hook-nail deformity. In the static two-point discrimination test, the mean value was 4.61 mm in the injured finger. Patient ratings of the outcomes were “excellent” in 18 and “good” in 5 cases. ConclusionThe V advancement eversion flap technique, when properly designed and executed in fingertip amputation cases, can minimize morbidity and result in successful wound healing without flap necrosis and hook-nail deformity.

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations.

Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss. Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively. Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5. The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.

Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of Carpal tunnel syndrome: an assessor-blinded randomised controlled trial

ObjectivesTo compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial...

Outcomes of antegrade homodigital neurovascular island flap in fingertip amputations

BackgroundAntegrade homodigital neurovascular island flap (AHIF) is one of the methods used in fingertip amputations to cover the defect area, preserve finger length and obtain a painless and sensitive fingertip. The aim of this study was to evaluate the functional and sensory outcomes in patients who underwent AHIF for fingertip amputation and to analyze the relationship between patient satisfaction and outcome measures. MethodsTwenty patients with a mean age of 37 (18–63) years were analyzed retrospectively. The patients were evaluated in terms of hook nail development, active interphalangeal joint movements, cold intolerance, and sensory function of the flap covered area. Static two-point discrimination test and Semmes Weinstein monofilament test were performed for sensory evaluation. ResultsAll flaps survived completely at the end of follow-up (mean, 36 months; range 11–64 months). Five patients had cold intolerance and two had hook nails. In total, proximal interphalangeal or distal interphalangeal joint flexion contracture developed in 25 % of the patients. The mean static two-point discrimination score was 4.6 ± 1.6 (2–8) and Semmes–Weinstein monofilament test score was 3.48 ± 0.6 (2.44–4.17). Subjective satisfaction levels of the patients were found to be high and did not show a statistical relationship with the measured clinical outcome parameters (p > 0.05). ConclusionsSince AHIF contains a solid and continuous neurovascular pedicle, the probability of necrosis and loss of sensation is low in AHIF. In addition, the graft need of the donor area is not high. Its disadvantage is the rate of restriction of joint movements. Level of evidenceIV.

P3 Flap: Technique for Fingertip Reconstruction

Summary: Fingertip amputations represent an important spectrum of injuries, and most are avulsions or crush trauma. There is no consensus about one single standard treatment, and a wide number of techniques are available. The authors present the P3 flap as an option for covering fingertip defects with bone exposure, avoiding painful scars in the pulp area, without a donor site. This study included 12 fingertips with amputated segment not available for replantation. Volar oblique fingertip defects and transverse amputations with bone exposure, not more proximal than Hirase Zone IIB, were included. Defects were less than 2 cm. The patients were followed up for an average of 6 months. The aesthetic and functional outcomes and fingertip discrimination recovery were evaluated at 6 months by the static two-point discrimination (2-PD) test and DASH score (quick version). The average postoperative 2-PD test at 6 months was 5.9 mm (range from 5 to 8 mm). The mean healing time of the fingertip was 4 weeks. Nail deformity was reported in three cases with level IIB of amputation. None of the P3 flaps failed, and local infection was not reported. The average DASH score at 6 months was 1.1. The mean time to return to work was 38 days (range from 30 to 53). The P3 flap proposed in this study demonstrates a reliable single-stage technique, performed under local anesthesia, for fingertip defect reconstruction, avoiding skin incision and scars in the pulp region and preserving digital length and nail bed.

STUDY OF FINGERTIP RECONSTRUCTION USING CROSS FINGER FLAP AND FTG

Objectives: Fingertip injuries are frequent and there are many techniques used for reconstruction fingertip injuries. The authors reviewed the outcomes of fingertip reconstruction, including sensation and shape, using the combined technique of the cross-finger flap and full thickness skin graft and defined the optimal dimensions of fingertip defect that is applicable to this technique. Between 2019 and 2021, 40 cases, aged 3-60 years (mean, 28.1 years), who hadMethods: undergone fingertip reconstruction using a combination of the cross-finger flap and full thickness skin graft were reviewed. The presence of fingertip and nail deformity and the results of the Semmes-Weinstein (S-W) monofilament and static two-point discrimination tests were analyzed. Fingertip deformities were noted in 12 cases whereResults: the defect was more than 50% of the Tamai zone I or extended to zone II. Mild nail plate deformity was found in 12 cases with more than 40% of the nail bed defect. 8 out of these 12 cases presented with partial phalangeal tuft defects. 32 fingers were examined using the Semmes-Weinstein test, and their scores were between 2.83 and 4.31 in 20 fingers and 4.56 in 12 fingers. 24 were examined for static two-point discrimination, with 5 mm in 12, 6 mm in 4, and 10 mm in 2. The color and contour of all donor fingers were almost typical. The combination of the cross-finger flap andConclusions: full-thickness full thickness skin graft is applicable to around 50% of fingertip defect within the Tamai zone I, achieving a satisfactory shape and regaining more than protective sensation.

Comparison of prognosis in two methods for the lingual nerve repair: direct suture with vein graft cuff and collagen allograft method

BackgroundNo studies have compared the outcomes of direct perineurial suture with vein graft cuff repair and indirect collagen allograft repair of the lingual nerve following an injury. Therefore, we evaluated and compared the outcomes of each over a 1-year observation period. We retrospectively assessed 20 patients who had undergone microneurosurgical repair of unilateral lingual nerve injuries at the Wakayama Medical University Hospital between May 2015 and March 2019. We utilized two different methods for lingual nerve repair, i.e., direct perineurial repair with a vein graft cuff and interpositional collagen allograft repair. Sensory and taste function in the lingual nerve were preoperatively evaluated using a static two-point discrimination test, superficial pain/tactile sensation test, tests for the pressure pain threshold (Semmens-Weinstein monofilament), test for thermal discrimination hot and cold sensation, and a taste discrimination test. These tests were performed again at 6 and 12 months postoperatively.ResultsCompared to the preoperative conditions, all patients showed improved sensory reactions. Functional sensory recovery outcomes were defined by Pogrel’s criteria, Medical Research Council Scale grades, and functional sensory recovery. In each group, all patients improved after the operation. However, the operation time was significantly shorter for an interpositional collagen allograft repair as compared to that for a direct perineurial repair with a vein graft cuff.ConclusionsThere were no statistically significant differences between the two repair Methods, except for the operation time. Both methods led to satisfactory results for all criteria. From an economic point of view, direct perineurial repair with a vein graft cuff is meaningful; however, the esthetic effect on the donor site should be considered. Conversely, interpositional collagen allograft repair has the advantage of a greatly shortened operation time.

The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction.

BackgroundTo explore the clinical effect of digital dorsal fascial island flap combined with crossfinger flap to repair distal degloving injury and sensory reconstruction.MethodsA total of 19 patients with distal fingertip degloving injuries treated with digital dorsal fascial island flap combined with crossfinger flap in our hospital from April 2018 to August 2020 were retrospectively included. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the fingers, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were evaluated.ResultsFive cases with post-operative flap blisters were treated at the time of dressing changes until successful scab formation. Three cases with post-operative arterial crisis of finger arterial dorsal branch vessel were relieved after suture removal and tension reduction. All other skin flaps and skin grafts survived. Nineteen patients received follow-up between 3 and 26 months (average 14.6 months). The active ROM of metacarpophalangeal (MCP) and interphalangeal (IP) joints of the injured fingers were satisfactory.ConclusionThe digital dorsal fascial island flap combined with the crossfinger flap for repairing the distal degloving injury of the distal segment of the finger is a good surgical method, which is simple and easy to operate, can repair a large area of soft tissue defect, and obtain a satisfactory effect.

Reverse homodigital dorsoradial flaps for thumb coverage obtained good sensory recovery after a long time follow up

Reverse homodigital dorsoradial flap (RHDF) of the thumb has become a qualified option for the reconstruction of thumb tissue defects. However, the sensory recovery of the flap in long term is still unknown. Therefore, this study focused on the sensory recovery of RHDFs for the coverage of thumb in hand after a long-term follow-up. From January 2010 to March 2011, 18 patients (14 men and four women) were treated consecutively with an RHDF. All the patients were followed up two times. The pain and cold intolerance of the flap were self-reported by the patients. The sensory recovery of the flap was evaluated using Semmes–Weinstein (SW) monofilament, moving two-point discrimination (M-2PD) and static two-point discrimination (S-2PD) tests. The average times of the first and second follow-up were 39 ± 4 and 88 ± 6 months, respectively. The mean value of SW monofilament sensitivity score and M-2PD at first follow-up was significantly higher than that of the second follow-up and contralateral thumb. The mean value of S-2PD at the second follow-up was significantly lower than that of the first follow-up and higher than that of the contralateral thumb. The cold intolerance severity score (CISS) at the first follow-up was higher than that at the second follow-up. No significant difference was found in terms of the pain between the two follow-ups. RHDFs without nerve coaptation for thumb coverage could obtain good sensory recovery after a long-term follow-up. Abbreviations: RHDF: reverse homodigital dorsoradial flap; CISS: cold intolerance severity score; SW: Semmes–Weinstein monofilament sensitivity score; M-2PD: moving two-point discrimination; S-2PD: static two-point discrimination; VAS: visual analog scale.

Evaluation of versatility and outcomes of the first dorsal metacarpal artery flap in thumb defects.

It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options. A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature. The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0-10). The sensory outcome was 'good' (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0-5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0-100). Complete cortical reorientation was seen in 81% of the patients. Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.

Long-term clinical outcomes of innervated digital artery perforator flap in the treatment of fingertip injuries.

The aim of this study was to evaluate the long-term clinical outcomes of innervated digital artery perforator (IDAP) flap in the treatment of patients with fingertip injuries. Eighty-three patients (93 fingers; 70 male, 13 female; mean age = 35.2 years, age range = 5-65) with fingertip injuries who underwent acute or late reconstruction with IDAP flap between 2011 and 2016 were retrospectively reviewed. The mean age was 35.2 (range = 5-65) years. Reconstructions performed in 85 fingers (91.4%) were acute, and 8 fingers (8.6%) were late. Hypersensitivity, cold intolerance, and patient satisfaction were questioned as subjective evaluation parameters. The objective patient outcome evaluations consisted of static two-point discrimination (s2PD) test, the Semmes-Weinstein monofilament (SWM) test, and range of motion of the reconstructed fingers. The mean follow-up period was 33.1 (range = 12-62) months. The smallest flap size was 1.6 x 0.7 cm; the largest flap size was 4 x 2 cm. All flaps survived completely. There was no postoperative infection or donor site morbidity. Hyperesthesia was observed in 4 fingers (4.3%), of which 3 were mild and 1 was moderate. Eighteen patients (18 fingers, 19.3%) experienced mild cold intolerance on reconstructed fingertips. 75 patients (90.3%) were highly satisfied, and 8 patients (9.7%) were satisfied with functional and aesthetic results of their fingertip reconstructions. No range of motion limitation was observed in any joints of 90 fingers (96.8%). The s2PD in the flaps ranged from 2mmto 6mm(mean = 3.71 ± 0.97 mm), compared with 2mmto 5mm(mean = 2.73 ± 0.66 mm) on the contralateral hand. TheSWMtest results of the flaps ranged from 2.44 to 4.56, compared with 2.44 to 4.31 on the contralateral hand. The difference regarding s2PD and SWM test was statistically significant (P < 0.001). IDAP flap seems to be a sensate, reliable, and versatile flap that can be used in acute and late reconstructions of any type of fingertip defects. Satisfactory functional and aesthetic results can be achieved with better sensorial results and lower complication rates compared to other conventional reconstruction techniques. Level IV, Therapeutic Study.

Comparative assessment of fingertip replantation in paediatric and adult patients within a single institution.

The purpose of this retrospective study was to compare the outcomes of paediatric and adult fingertip replantation within a single institution. Our retrospective study found no significant difference in the survival rate between the paediatric (10/12) and adult (22/26) groups. At 6months follow-up, there was no significant difference in sensory recovery between both groups, as measured with Semmes-Weinstein testing, but a significant difference in mean static two-point discrimination testing values between the paediatric (4.0 mm) and adult (6.2 mm) groups. Moreover, the mean time for regaining sensation was faster in paediatric patients (1.3months) as compared with adult patients (4.1months). Five children and four adults received erythrocyte transfusion. Paediatric fingertip replantation has similar survival rates, faster and better sensory nerve recovery as compared with adults despite a higher erythrocyte transfusion rate. Although technically demanding, paediatric fingertip replantation is recommended, whenever possible, because of the good outcomes achievable.Level of evidence: IV.

Clinical Features of Ulnar Tunnel Syndrome and the Diagnostic Value of Nerve Conduction Measurements.

ABSTRACTObjectives:The purposes of this study were to assess the clinical features of ulnar tunnel syndrome (UTS) and to investigate the diagnostic value of nerve conduction measurements for UTS.Methods:Eighteen patients with UTS were reviewed retrospectively. Fifteen patients had intrinsic muscle atrophy and motor weakness, and 15 had numbness with hypesthesia. The compound muscle action potentials (CMAPs) from the first dorsal interosseous (FDI) muscle and the abductor digiti minimi (ADM) muscle and the sensory nerve action potential (SNAP) from the little finger were recorded and analyzed. All patients underwent ulnar tunnel release surgery and neurolysis. Static two-point discrimination test results and pinch strengths were assessed before and after surgery.Results:Before surgery, FDI-CMAP was recorded in 17 patients, and ADM-CMAP in 16, and all showed delayed latency and/or low amplitude. SNAP was recorded in eight patients and two showed delayed latency. The causes of ulnar nerve lesions were ganglion in five patients, traumatic adhesion in four, ulnar artery aberrancy in four, pisohamate arch in three, anomalous muscle in one, and ulnar vein varix in one. The sites of the lesions were in zone 1 of the ulnar tunnel anatomy in 12 patients, in zone 2 in 2, and in zones 1 and 2 in 4. After surgery, all patients obtained recovery of motor function and sensation; however, postoperative FDI-CMAP and ADM-CMAP did not improve to the normal range.Conclusions:The causes of UTS were ganglion, traumatic adhesion, ulnar artery aberrancy, and pisohamate arch. Both FDI-CMAP and ADM-CMAP were valuable for electrophysiological diagnosis of UTS.

Blink reflex changes and sensory perception in infraorbital nerve-innervated areas following zygomaticomaxillary complex fractures.

BackgroundInfraorbital nerve dysfunction is commonly reported after zygomaticomaxillary complex fractures. We evaluated sensory changes in four designated areas (eyelid, nose, zygoma, and lip) innervated by the infraorbital nerve. This evaluation was conducted using the static two-point discrimination test and the vibration threshold test. We assessed the diagnostic significance of the blink reflex in patients with infraorbital nerve dysfunction.MethodsThis study included 18 patients, all of whom complained of some degree of infraorbital nerve dysfunction preoperatively. A visual analog scale, the infraorbital blink reflex, static two-point discrimination, and the vibration threshold were assessed preoperatively, at 1 month postoperatively (T1), and at a final follow-up that took place at least 4 months postoperatively (T4). The results were analyzed using a multilevel generalized linear mixed model.ResultsScores on the visual analog scale significantly improved at T1 and T4. The infraorbital blink reflex significantly improved at T4. Visual analog scale scores improved more rapidly than the infraorbital blink reflex. Two-point discrimination significantly improved in all areas at T4, and the vibration perception threshold significantly improved in the eyelid at T4.ConclusionsRecovery of the infraorbital blink reflex reflected the recovery of infraorbital nerve dysfunction. We also determined that the lip tended to recover later than the other areas innervated by the infraorbital nerve.

Fingertip defect reconstruction with a modified pivot flap.

The pivot flap can treat volar oblique defects of the fingers distal to the distal interphalangeal joint. We present our experience in 11 fingers (11 patients) using this flap, including some modifications that optimize flap harvesting, mobilization, inset, and vascular supply and outcomes. The flaps harvested had an average size of 2.4 × 2.0 cm. The patients were followed for an average of 21months (range 12 to 36) after surgery. Sensitivity of the flap was evaluated with the Semmes-Weinstein monofilaments test and static two-point discrimination test. Cold intolerance was also evaluated. The pivot flap with the modifications demonstrates a reliable technique for fingertip defect reconstruction. The results, in terms of sensitivity and functional recovery, seem promising.Level of evidence: IV.

Repair of distal thumb degloving injury using combination of reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap

BackgroundTo examine the efficacy of combination of the reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap for repair of distal thumb degloving injury.MethodsTwelve patients with mechanical distal thumb degloving injuries were treated between February 2017 and August 2019. A combination of the reverse dorsoradial flap of the thumb and the middle finger proper digital arterial island flap were used. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the joints, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were sequentially evaluated.ResultsTwo cases with postoperative flap blisters were treated at time of dressing changes up to successful scab formation. One case with postoperative arterial crisis of finger arterial dorsal branch vessel was successfully released in the pedicle. Ten cases healed by first intention and 2 cases by secondary intention. Twelve patients received follow-up examinations between 3 and 20 months (average 13 months) post-treatment, and all exhibited full, soft flaps with no fingertip pain.ConclusionThe combined use of the reverse dorsoradial flap of the thumb and the middle finger proper digital arterial island flap is a practical and effective approach to surgical repair of distal thumb degloving injuries.

Patient satisfaction after innervated digital artery perforator flap for fingertip injuries.

The aim of this study was to evaluate the results of the innervated digital artery perforator (IDAP) flap and to analyze the relationship between patient satisfaction and outcome measures. A total of 17 fingertips of 15 patients (14 men and one woman; mean age: 47.2 (26-62) years) were included in this retrospective study. Patients' injured finger and defect type were recorded. At the last follow-up, the static two-point discrimination (s2PD) test, Semmes Weinstein monofilament (SWM) test, and range of motion of the affected finger were analyzed. We interviewed patients to determine hand dominance, cold intolerance, and their satisfaction with the result. We performed correlation and logistic regression analyses between patient satisfaction and outcome measures. The mean follow-up period was 13.8 (7-18) months. The mean range of motion was 77.3±3.5 (70-80) degrees for the distal interphalangeal joints of affected fingers. The mean s2PD was 6.4 (3-10) mm, and the SWM records ranged from 2.83 to 4.93 monofilament markings. Cold intolerance was noted in seven fingers (41%). Patient satisfaction was negatively correlated with cold intolerance, and cold intolerance decreased as the follow-up period extended. IDAP flap satisfies both patient and surgeon, with the only significant problem being cold intolerance, regarding which patients must be informed. Although cold intolerance is hard to treat, fortunately, it generally improves with time. Level IV, Therapeutic study.

Application of a modified dorsoulnar artery pedicle flap in the repair of thumb tip defects: A case report.

Between February 2012 and March 2014 10 patients were admitted to the Affiliated Hospital of Nantong University for surgery due to a thumb tip defect. Nine of these patients were male and one was female and there were 7 cases of left thumb defects and 3 cases of right thumb defects. The surgical procedures followed were first, modification of the flap tail to an equilateral triangle, which facilitated pedicle suturing of soft tissue defects, caused mild tension and effectively reduced venous disorders, and second complete opening of the flap pedicle to the soft tissue defects at the tunnel. All patients were followed up at 6 and 12 months after surgery. Grip and pinch strength were measured 6 and 12 months after surgery. Static two-point discrimination testing of the modified flap showed minor differences from the uninjured hand. Post-surgery grip and pinch strength were restored to approximately 85% of the level of that in the uninjured hand. The modified dorsoulnar artery pedicle flap provided excellent thumb tip defect coverage and is an effective and safe technique for the restoration of grip and pinch strength to the hand after the repair of a thumb tip defect.

Favorable long-term esthetic, functional, and sensory outcome and preferability of distal digital replantations

Background: To evaluate long-term esthetic, functional, and sensory outcome and preferability of distal digit replantations with respect to contralateral intact finger. Materials and Methods: A total of 63 single-or multi-digit clean cut amputations distal to distal interphalangeal joint (DIPJ) involving nail fold in 45 consecutive patients (mean 29 years, 26 males, 19 females) who underwent replantation surgery between 2010 and 2016 were included in this study. Esthetic outcome, functional, and sensory outcome were assessed in the postoperative 6 months, 1 year, and 3 years. Results: Single-digit amputation was noted in 34 patients including thumb (n = 9), index finger (n = 10), middle finger (n = 7), ring finger (n = 7), and little finger (n = 1). Multi-digit amputations were evident in 11 patients involving 2 fingers in five patients (index + middle in two patients, middle + ring in two patients, and thumb + index in one patient), 3 fingers in five patients (index + middle + ring in 4 patients and middle + ring + little in one patient), and 4 fingers in one patient (index + middle + ring + little). All patients were operated within the first 4 h of hospital admission. Postoperative 3-year outcome was excellent in 79.3% of operations, good in 14.2%, and acceptable in 6.3% of operations. None of the operations resulted in poor or very poor outcome and none of the patients had functional loss during the entire follow-up period. A very satisfactory sensory outcome with static two-point discrimination test findings of