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At least 397 records · Page 22Linked to original sources
PubMed2005

[Bilateral three-toe transplantation with dorsalis pedis flap and first web space flap for damage injury in the hands].

OBJECTIVE: To discuss the surgical method and effect of repair of damage injury in the hands. METHODS: Of the 29 cases, 22 were males, 7 were females. Their ages ranged from 15 to 31. The size of defect areas ranged from 18 cm x 8 cm to 22 cm x 10 cm. Along with dorsalis pedis flap, lateral hemi-pulp flap was taken from great toe and first web space flap. The second toe was taken from one foot to reconstruct the thumb, second and third toe from another foot was used to reconstruct two fingers. The dorsalis pedis flaps were used to cover palm and dorsum of hand. The lateral hemi-pulp flaps from great toe and first web space flaps were used to reconstruct first web space of hand. RESULTS With the 58 combined flaps, 29 thumbs and 58 fingers were reconstructed. Follow-ups was done for 1 to 8 years. All the thumbs and fingers of 29 hands were reconstructed. Their shape and function were well recovered. CONCLUSION: This new surgical method is effective in preserving the function of injured hand. The function of the injured hands can be preserved by this surgical method, therefore this method is optimal.

Adolescent↗
PubMed2005

Species distribution and frequency of isolation of yeasts and dermatophytes from toe webs of diabetic patients.

The paper identifies fungal species, looking at the incidence of fungal isolation and risk factors influencing the development of fungal infection and colonization of interdigital spaces of the feet in 509 diabetic outpatients. Using standard mycologic diagnostic methods, fungi were detected in toe webs of 122 (24%) diabetic patients. The finding of fungi was twice as common in interdigital spaces of one (85/16.7% of the patients) than both feet (37/7.3% of the patients). Yeasts were the most common isolates (95/18.7% of the patients), followed by dermatophytic moulds (24/4.7% of the patients), whereas coexistence of yeasts and dermatophytes was the most infrequent finding (3/0.6% of the patients). From toe webs, 24 fungal species, 21 yeast species belonging to nine genera (Candida, Rhodotorula, Cryptococcus, Trichosporon, Saccharomyces, Blastoschizomyces, Geotrichum, Debaryomyces, and Ustilago) as well as three species of dermatophytes of the genera Trichophyton and Epidermophyton were isolated. The most frequently isolated fungi were Candida parapsilosis (59/11.6% of the patients) and Trichophyton mentagrophytes (16/3.1% of the patients). Although there was no correlation between the incidence of toe web space colonization with yeasts and dermatophytosis with the criteria of patient sex and age, and duration of diabetes, the difference in the incidence according to type of diabetes was statistically significant. In non insulin dependent diabetes mellitus patients, the incidence of fungal isolation from toe webs was statistically significantly higher (30.1%) than in insulin dependent diabetes mellitus patients (19.8%).

Adult↗
PubMed1991

[Ingrown nail of the great toe treated with partial resection of the nail-forming matrix].

During the period 1.3.1976 to 31.5.1989, 158 patients were treated for in-growing toe-nail of the great toe by partial resection of the nail-forming matrix. The average age was 26 years and the period of observation was 83 months. A questionnaire was sent to all of the patients and 119 patients with 154 nails submitted to operation replied (75.3%). Ninety-five patients (79.8%) had no discomfort and seven (5.9%) stated that the condition had improved. Ten patients (8.4%) were submitted to reoperation. Seventy-six patients (63.9%) were completely satisfied with the cosmetic result of the treatment. Significantly better results as regards discomfort were obtained in patients who had been treated preoperatively by avulsion of the nail so that infection and inflammation had resolved (p less than 0.05). The authors conclude that partial resection of the nail-forming matrix is a certain and effective method of treating in-growing toe-nail of the great toe and they recommend that the nail is avulsed prior to operation.

Adolescent↗
PubMed1989

Thumb reconstruction--great toe transfer.

Thumb reconstruction has a long and exciting history spanning more than 100 years. Reflecting on the evolution of techniques, the problems encountered and solved, and the advancement of technologies, one is struck by the versatility of surgeons in their varied approaches to the restoration of the thumb. Philosophical differences over the relative advantages and disadvantages of each operation have fueled debate over the choice of technique, but a unifying concept in reconstruction "to replace the lost tissue with like tissue" must be sought. The ideal reconstruction is one that replaces all of the lost structures, provides restoration of all function, and has no donor site morbidity. Homotransplantation of the thumb fits each of these criteria and may well be available some day. The experimental work of Furnas and others with limb transplantation is bringing us ever closer to realizing this goal. Even now, cadaver preparations of bone, joint, and tendon together with wrap-around flaps are being used clinically for thumb reconstruction. The initial reports are favorable, and these procedures portend exciting prospects for the future when immunological barriers can be selectively overcome. Some 10 years ago Dr. Littler, in discussing thumb reconstruction, wrote "Just as the neurovascular pedicle method of composite tissue transfer unshackled the older but limited procedures and made possible more accurate planning in substituting for the structural loss, so must the new freedom, afforded the transfer of composite tissue through microvascular surgery, not fail to utilize established structural and functional principles. Nor must the urge to use the free transfer method lure the surgeon from a safer, more predictable procedure." In the decade since Dr. Littler expressed these sentiments, a great deal of progress has been made in microsurgery, and we feel that there is ample evidence in our clinical experience as well as that of the literature to allow us to state with confidence that great toe to thumb transfer is a safe, reliable, and efficient means of thumb reconstruction that offers significant advantages over other techniques and few disadvantages. Anatomically, the great toe is nearly identical to the thumb and provides a transplant with tendon, bone, joint, and innervated skin elements that, in many instances, restores the attributes of the lost thumb in a superior fashion compared with other procedures. Our series now consists of 80 great toe transplants and the results continue to be gratifying. In short, great toes make great thumbs.

Humans↗
PubMed1989

The pathological anatomy of claw and hammer toes.

We sought to determine the optimum surgical treatment of claw and hammer toes (except for the hallux) on the basis of the specific pathological anatomy of each type of deformity. We dissected thirty-three fresh-frozen specimens that had been obtained from below-the-knee amputations. The specimens included ten normal feet, fourteen feet that had claw toes, six feet that had hammer toes, and three feet that had an uncategorized deformity. The contributions of abnormalities of the skin, tendons, joint capsule, and collateral ligaments to deformity of the metatarsophalangeal and proximal interphalangeal joints were determined by sequential sectioning of all of those soft-tissue components. Any alteration in the range of motion of the joints was recorded after each stage of the dissection. The findings of this study suggested that surgical correction of claw and hammer toes may necessitate more extensive sectioning of the soft tissues than had previously been believed.

Foot Deformities, Acquired↗
PubMed1988

An irreducible dislocation of the great toe. Report of two cases and review of the literature.

Irreducible dislocation of an interphalangeal (IP) joint of the great toe is a rare condition. Twenty-two cases including the present two cases are reported in available literature. Two different types are identifiable. In one type, where the ruptured volar plate is displaced into the joint space between two phalanges, the toe is slightly elongated, but the deformity of the toe is not so marked. In the other type, where the volar plate is completely displaced over the proximal phalangeal neck, the deformity of the toe is extreme as the IP joint is locked in hyperextension. In the former type, the dislocation is often misinterpreted to have been repositioned manually because of relatively slight deformity. In either type of dislocation, the volar plate is detached from both the distal and proximal phalanges, and so displaced into the joint, as to form a barrier to manual repositioning. Open reduction is mandatory.

Adult↗
PubMed1986

Gait electromyographic evaluation of the long-toe flexors in children with spastic cerebral palsy.

In a prospective study of the phasic activity of the long-toe flexors of patients with spastic cerebral palsy, the electrical activity of the long-toe flexors in 37 children with varus or valgus hindfoot deformity was measured by wire electrode dynamic electromyography. Although gross abnormalities in the phasic timing of the flexor hallucis longus and flexor digitorum longus were observed, these muscles could not be implicated in the etiology of hindfoot deformity. In planning gait analysis protocols for children with cerebral palsy and hindfoot deformity, electromyography of the long-toe flexors is not necessary unless toe curling is clinically evident.

Cerebral Palsy↗
PubMed1986

Handedness, footedness and finger and toe movement-related cerebral potentials.

Sixteen right-handed and 16 left-handed subjects were compared with respect to their foot dominance and the topography of their pre-movement cerebral potentials (Bereitschaftspotential, BP). First, righthanders were usually also found to be right-footed. Lefthanders showed a similar trend in preferring their left foot. Second, the BP prior to volitional self-paced movements of fingers and toes on either side was examined. For finger movements, the BP always showed higher amplitudes over the contralateral hemisphere as compared to the ipsilateral one (contralateral preponderance of negativity, CPN). For toe movements a significant ipsilateral preponderance of negativity (IPN) occurred in all subjects. The CPN was larger for finger movements of the dominant hand than it was for finger movements on the non-dominant side. By contrast, the IPN was larger prior to movements of the "non-dominant toes" than it was for movements of the dominant toes. This can be explained by assuming that the hemisphere contralateral to the dominant hand, generates more negativity than the one contralateral to the non-dominant hand. This assumption is further discussed in the context of a vector model for the BP.

Adolescent↗
PubMed1985

Orthostatic changes in first-toe blood pressure in normal subjects and in patients with occlusive arterial disease.

Orthostatic changes in first-toe systolic blood pressure, measured with cuff and strain-gauge technique, were compared with changes expected according to hydrostatic calculations. Twenty-five limbs with occlusive arterial disease were studied. When the first toe was lowered 40 cm below the heart, the toe blood pressure--corrected for changes in systemic blood pressure--rose on median 3.9 (-8.7 to 11.4) mmHg more than expected. The difference was statistically significant. Elevation of the first toe 40 cm above the heart did not lead to significant deviation from the expected blood pressure. Twelve normal limbs showed no significant deviations in blood pressure during the orthostatic changes. It is proposed that the additional increase in the indirectly measured systolic pressure also represents an additional increase in the mean arterial blood pressure. The mechanism of this additional increase seems to be reflex vasoconstriction in the distal tissues, reducing the pressure gradient across the proximal collateral vessels. The additional increment may contribute to the abnormalities of local blood flow regulation observed in ischaemic limbs.

Adult↗
PubMed1985

[Anatomical variations in blood vessels and their effect on the technic in toe transfer].

In the absence of grasp, either traumatic or congenital, free transfer of the second toe to the hand is one of the reconstructive possibilities. An essential prerequisite for the acceptance of the transferred toe is a guaranteed blood supply through the vascular pedicle. The blood supply of the second toe can be either by dorsal or plantar arteries, a fact which is due to anatomic variations. Through preoperative angiographic examination the arterial blood supply of the second toe can be defined. The location and length of the vascular pedicle have to be considered in the design of the anastomosis with the recipient vessels of the hand.

Adolescent↗
PubMed1985

[Swanson silastic implant arthroplasty in pathology of the metatarsophalangeal joint of the great toe].

Fifty-one disorders of the metatarsophalangeal joint of the Great Toe have been treated by implantation of a Swanson silastic prosthesis. A finger-joint device was used in 29 cases and a Great Toe device in 22 cases. The pathological lesions were degenerative arthrosis, rheumatoid arthritis or failure of preceding procedures. The mean follow-up was 3 years. In more than 2 cases out of 3 pain was abolished. Joint movement was only slightly improved but there was a better range of dorsiflexion and an improved gait. The axis of the Great Toe was generally satisfactory and pre-existing deformity was corrected in 3 cases out of 4. These results are satisfactory in the short term and were better with the Great Toe device. Osteophytic reaction may be the cause of long-term failures.

Arthroplasty↗
PubMed1985

Nutritive toe skin capillaries in middle-aged patients with diabetes mellitus.

Vital capillary microscopy was employed in a study of the toe dorsum capillaries in 92 middle-aged diabetics and 96 controls of similar age and sex distribution. As a general finding most vision fields in the same toe showed an almost identical capillary pattern. In 17% of the toes in the controls compared to about 35% of the toes in the patients the capillaries were dilated more than 3 times. Such findings were unrelated to blood glucose control and a number of metabolic variables. In the patients with non-insulin dependent diabetes an abnormal capillary pattern was particularly common in patients with evidence of obstructive arterial disease. Such a relationship was not observed in patients with insulin-dependent diabetes in whom changes in the capillary pattern to a higher extent may be related to other mechanisms such as neuropathy.

Aged↗
PubMed1984

Comparison of resting capillary flow dynamics in the finger and toe nailfolds.

The purpose of this study was to compare capillary dynamics in the nailfold regions of the human toes and fingers. Capillary blood flow velocity (VEL), vessel diameter, the total number of capillaries and the number of capillaries with active flow per mm2 of tissue were measured in the toe nailfold region of 17 and in the finger nailfolds of 15 male subjects 20 to 40 years of age. All measurements were made in the rest state at a skin temperature of 32 degrees C. Group averages were: (Formula: see text). These results demonstrate that compared to the finger the nailfold capillaries in the toe have a lower blood flow per vessel but a much higher capillary density. The combination of these factors indicates that total capillary blood flow is higher in the toe nailfold system.

Adult↗
PubMedDate not supplied

Noninvasive assessment of toe systolic pressures with special reference to diabetes mellitus.

Toe and ankle systolic blood pressures were measured noninvasively in asymptomatic volunteers and in patients with peripheral arterial obstructive disease. The measurement of ankle pressure was falsely elevated in 23% (51/219) of the diseased limbs studied, as a consequence of partial or total vessel incompressibility caused by arterial calcification and rigidity. Eighty percent (41/51) of limbs with erroneous ankle pressure readings were from patients with diabetes mellitus. Toe pressure was the most reliable indicator of occlusive disease, and was able to assess disease distal to the ankle. Five groups were separated using the ankle-brachial and the toe-ankle systolic pressure ratios: normal, claudication, limb salvage, claudication/incompressible arteries, and limb salvage/incompressible arteries. Insulin dependent and orally-medicated diabetics predominated in the two groups with incompressible arteries. The toe-brachial systolic pressure ratio was an accurate hemodynamic indicator of total peripheral arterial obstructive disease.

Ankle↗
PubMed1980

Correction of hammer toe surgery deformity by Z-plasty and bone graft.

Some of the older orthopedic techniques for correcting hammer toes and corns called for major resection or even total resection of a phalanx of the toe. The late result of some of these procedures was a deformed, flail, or contracted toe on the dorsum of the foot. The patient described had such deformities on both little toes. Surgical correction included Z-plasties for the skin, extensor tendon resection, and bone grafts. Three-year follow-up has shown the technique to be a safe and satisfactory long-term method of reconstruction.

Adult↗
PubMed1981

[Thumb replacement by transplantation of the 2d toe].

After traumatic loss, the thumb can now be replaced by transfer of the toe due to the development of microvascular techniques. Because of the better aesthetic and functional result in the donor foot we prefer the second toe to the big toe. By including a part of the second metatarsal bone the length of the second toe transplants can be adjusted appropriately. In this report the operative technique and the result of eight of such procedures with seven successes is described.

Amputation, Traumatic↗
PubMed1994

[Second toe transplantation in loss of a long finger. Indications--planning--technique].

Transplantation of the second toe is a routinely employed method in reconstructive hand surgery. Most often it is used for thumb or midhand amputations. Following partial amputations of digits distal to the MP-joints, toe transplantations are less frequently employed. However, function as well as cosmesis of the hand after partial amputation of digits can considerably be improved by toe transplantation. The length of the reconstructed finger is a most important aspect of operative planning which has influence on operative technique as well as functional and aesthetic results. A smooth junction at the base of the transplanted toe should be maintained. This can be achieved by adequate soft-tissue reduction and exclusion of the metatarsophalangeal joint. Anastomoses of the subcutaneous venous and plantar as well as dorsal arterial vascular systems are recommended.

Amputation, Traumatic↗
PubMed1994

Reconstruction of four damaged or destroyed ipsilateral fingers with free toe-to-hand transplantations.

Three patients with traumatic partial or complete loss of all ipsilateral digits, excluding the thumb, were reconstructed with free microvascular toe transplantations for all involved digits. In two cases, two pairs of combined second and third toe transplantations were utilized; in the third case, four separate toes were employed. Clinical follow-up was 8 1/2 years, 2 years, and 1 2/3 years. Detailed functional analysis was performed. All patients except the first had initially undergone reconstruction of only two digits and had requested a second procedure to transfer two additional toes. While reconstruction of the thumb and two opposing digits is adequate in most cases, selected patients may benefit from the additional two digits, especially with respect to improving hook grip.

Adolescent↗