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PubMed1992

Continuous local intraarterial infusion after prolonged arterial stasis in the fingers and toes.

Seven patients with trauma to eight digits and one toe went untreated for arterial stasis, with subsequent development of posttraumatic changes in skin coloration. In two patients involving two digits, a daily dose of 2,000 ml containing 240,000 U urokinase, 80 micrograms prostaglandin E1, and 10,000 U heparin in lactated Ringer's solution was administered by intravenous infusion for 10 consecutive days; one of the two digits became necrotic. In all subsequent patients, a daily dose of 80 ml containing 240,000 U urokinase, 40 micrograms prostaglandin E1, 10,000 U (maximum) heparin, and low-molecular-weight dextran was administered by continuous local intraarterial infusion for 10 consecutive days. These seven extremities survived, even in the case of two digits and one toe with over 50 hr of arterial stasis. We believe that revascularization of extremities following prolonged periods of arterial stasis may be possible by means of continuous local intraarterial infusion of antithrombotic agents.

Aged↗

PubMed1992

Experimental study of free toe replantation in rats.

A rat model for free second toe replantation, free hallux-to-thumb transplantation, and combined free hallux-to-thumb transplantation and free second-toe-to-index transfer is described. Experimental devices, operative methods, and the keys to success are discussed.

Animals↗

PubMed1993

Functional and esthetic reconstruction of a mutilated hand using multiple toe transfers and iliac osteocutaneous flap: a case report.

With reconstructive microsurgical techniques, some previously hopelessly mutilated hands have become reconstructable. The functional and esthetic results of such hands can be improved to an acceptable degree with through prereconstruction evaluation and planning. This case report demonstrates the approach to reconstruction of a mutilated hand using the following: a pedicle groin flap for soft tissue reconstruction of the first web space and the amputation stump of the thumb; a combined second and third toe transfer for reconstruction of opposable fingers at the amputated index and middle finger stumps; a single second toe for reconstruction of the thumb, and an iliac osteocutaneous flap for reconstruction of the ulnar border of the palm.

Accidents, Occupational↗

PubMed1993

Micro-anastomosis of 0.3-0.4 mm vessels after cold ischemia using a rat model of toe-to-thumb transplantation.

Anastomoses of vessels of less than 0.5 mm in diameter remain a challenge from the technical aspect. Clinically such anastomoses are necessary for replantation of the distal digit in adults and whole digits in children. Survival data for replantation of these parts after prolonged ischemia have not yet been reported. Since a rat foot has an anatomic structure similar to the human hand, we used 40 rats as models of toe-to-thumb transplantation to study the survival rates of transplanted toes after various periods of cold ischemia (4 degrees C) of the amputated part. While a 100% success rate was achieved following immediate transplantation of the amputated digits (control group), the survival rates were 87.5, 75, 75, and 62.5% after transplantation of digits cooled for 24, 48, 72, and 96 hours, respectively (groups 2-5). No exact ischemic time limit was demonstrated. The results suggest that, in this model, optimal digital replantation results are achievable even after a 24 hour period of cooling preservation.

Animals↗

PubMed1995

Delayed sensory reeducation after toe-to-hand transfer.

The effect of a delayed program of sensory rehabilitation was evaluated in 13 patients with a total of 22 toe-to-hand transfers. Each patient was begun on a protocol of sensory reeducation at a mean of 38 months (range 13-98 months) after the transfer. Home rehabilitation, employing a Disk-Criminator (TM) program, was monitored at monthly intervals by the therapist for a mean of 3.3 months, at which time a final evaluation of sensibility was done. Each of the 22 toe transfers improved by an average of 7 mm in static and 6 mm in moving two-point discrimination. The improvement in two-point discrimination following delayed implementation of sensory reeducation was statistically significant at the P < 0.0001 level.

Adult↗

PubMed1995

Thumb reconstruction with a free neurovascular wrap-around flap from the big toe: long-term follow-up of thirty cases.

From March 1982 to December 1992, 30 cases of thumb reconstruction with a free neurovascular wrap-around flap from the big toe were performed at Korea University Hospital. Twenty-nine of a total of 30 cases were successful and obtained excellent functional and cosmetic results. Postoperative complications included 1 case of graft failure, 6 partial skin necroses, 1 malunion, and 15 cases of resorption of iliac bone graft including 1 case of fatigue fracture of grafted bone. Even for the first metacarpal neck amputations, thumb reconstruction with a free neurovascular wrap-around flap was possible; however, limitation of motion of the reconstructed thumb and resorption of the grafted bone occurred. Thumb reconstruction with a wrap-around free flap from the big toe gives excellent cosmetic and functional results and causes minimal morbidity on the donor site.

Adolescent↗

PubMed2005

Salvage of free second toe with venous thrombosis by shunting retrograde arterial flow of second dorsal metatarsal artery.

Although there are case reports about salvaging amputated digits without venous return by shunting retrograde blood flow from a distal digital artery to a proximal vein (Smith et al., Plast Reconstr Surg 71:52, 1983), successful salvage of a congested free toe with efferent arteriovenous (AV) shunting retrograde arterial flow from the second dorsal metatarsal artery (SDMA) has never been reported. In this paper, we describe the possible factors for venous thrombosis, the errors we committed in the operation, and how the free toe can survive without venous drainage.

Adult↗

PubMed2002

A reconstructed digit by transplantation of a second toe for control of an electromechanical prosthetic hand.

The treatment options for the loss of an entire human hand and part of the forearm are currently limited to the transplantation of toe(s) to the amputation stump or a Krukenberg's bifurcation hand, and using a cosmetic or functional prosthesis. The functional prosthetic hand, such as the prevailing myoelectrically controlled prosthetic hand, has an action accuracy that is affected by many factors. The acceptance rate of the three planes freedom myoelectronic hand by the patients was 46-90% because of poor function caused by the weakness of signal and strong external interference. In this report, the left second toe was transplanted to the patient's forearm amputation stump. Mandates from the brain are relayed by the action of this reconstructed digit, to control a special designed multidimension freedom electronic prosthetic hand. After rehabilitation and adaptation training, the correct recognition rate of the electronic prosthetic hand controlled by this reconstructed digit is a remarkable 100%.

Adult↗

PubMed1990

Hypertrophic mononeuritis clinically presenting with painful legs and moving toes.

A 40-year-old woman presented with progressive lower leg pain and spontaneous toe movement. The EMG showed a posterior tibial nerve mononeuropathy and continuous myokymic discharges in posterior tibial-innervated muscles. The MRI revealed a markedly enlarged posterior tibial nerve. Toe movements and myokymia were unaffected by the proximal transection of the lesion but ceased abruptly when the distal end of the fusiform "tumor" was resected, suggesting that spontaneous electrical foci may have been located along the nerve lesion. The markedly enlarged nerve segment contained edematous, swollen fascicles with marked Schwann cell onion-bulb lesions and angiocentric, lymphocytic, and lymphofollicular infiltration. This nerve lesion is an example of a newly recognized entity called hypertrophic mononeuritis.

Adult↗

PubMed1984

Ainhum--an unusual presentation involving the second toe in a white male.

Ainhum (dactolysis spontanea) is most frequently seen involving the fifth toes of black men. An atypical case involving the second toes bilaterally in a white male is presented. The differential diagnosis, radiological findings and pathological appearance of this rare entity are discussed.

Ainhum↗

PubMed1989

Raynaud's phenomenon of fingers and toes of miners exposed to local and whole-body vibration and cold.

In a study of 27 underground miners exposed to hand or whole-body vibration, cold or other vasoconstrictive environmental factors, higher prevalences of Raynaud's phenomenon in both fingers and toes were found than in a control group not exposed to vibration. There were no Raynaud-like phenomena among miners not exposed to vibration. There was a positive correlation between the two locations. This may mean a general susceptibility of vasospasm, but it seems more probable that the disorders are caused by vibration exposure to fingers and toes.

Adult↗

PubMed1991

The development of the eye in homozygotes of the mouse mutant Extra-toes.

Mice homozygous for the Extra-toes mutation (Xt/Xt) die perinatally with multiple malformations involving the brain, the eye, the nasal mucosa, the face and the skeleton. We have investigated the development of the eye defect in Xt/Xt embryos until late gestation In early midgestation, three classes of homozygotes can be identified: some form an apparently normal optic cup and are associated with an apparently normal lens vesicle, some have distorted optic cups with abnormal and small lens vesicles, and others do not form an optic cup and have no lens placode or vesicle. In late gestation, some embryos have obviously continued to develop small eyes, which develop coloboma because the optic fissure in the optic nerve does not close. The others show degeneration of the optic nerve and eye cup, with no remnants of lenses. Even in the absence of an eye in these mutants, extra-ocular muscles develop. Upon comparison with other mouse mutants with eye defects, our data suggest that the malformation of the eye in Extra-toes homozygotes is due to the defective optic vesicle, and not as previously stated because of generic forces interfering with lens induction.

Abnormalities, Multiple↗

PubMed1993

The "blue-toe" syndrome as a harbinger of impending infrainguinal vein graft failure: a report of three cases.

Spontaneous "blue-toe" syndrome classically results from distal lower extremity microembolization of intraluminal atheromatous debris from a proximal source to the digital end arteries. During a 6-year period, 274 consecutive infrainguinal reversed vein arterial reconstructions were performed; in three patients (1.1% incidence), atypical distal microembolization originating from focal preocclusive intraluminal vein graft stenoses was identified. Sudden, spontaneous onset of ipsilateral blue-toe syndrome occurred at intervals of 4 to 11 months. Subsequent duplex scans and arteriography demonstrated patent grafts with high-grade, hemodynamically significant focal proximal short-segment sclerotic vein graft stenosis (n = 1) and midgraft valvular weblike stenoses (n = 2) with luminal irregularity. No other associated tandem lesions in the proximal or distal arterial tree were noted that would account for the microembolic phenomenon. The stenotic vein segments were excised with interposition vein graft replacement (n = 1) or with primary end-to-end reanastomoses (n = 2), resulting in complete resolution of the distal microembolic events without need for amputation. Histologic examination of these graft lesions demonstrated significant focal myointimal hyperplasia with adherent platelet aggregates and organized thrombus. The clinical presentation of distal lower extremity cutaneous digital ischemia consistent with microembolization developing ipsilateral to a previously placed vein conduit arterial bypass may signify a "failing" graft with a source from a preocclusive lesion. This finding should prompt aggressive evaluation and immediate revision to maintain assisted primary graft patency and prevention of tissue loss.

Blood Platelets↗

PubMed1998

[Free toe transplantation in reconstructive hand surgery].

Since the invention of microsurgical techniques the free toe-to-hand transplantation is an established method for reconstruction of hand function. The indication for this method following thumb and finger amputations as well as congenital defects with aplasia of the fingers and the thumb is discussed in comparison to alternative operations. The operative technique as well as the functional and aesthetic results that can be expected are described by presentation of clinical cases. Since 1992 we performed 18 free toe-to-hand transplantations for the above mentioned indications. Depending on the primary situation the elementary hand function with grip and pinch could be restored in all our patients using this method. Restoring sensibility next to length, mobility and strength in one operation has to be considered as an advantage compared to alternative methods.

Female↗

PubMed2005

[Lesser toe deformities. Definition, pathogenesis, and options for surgical correction].

Whereas in the past resection arthroplasty was - in analogy to hallux valgus surgery - the preferred therapy to correct lesser toe deformities, the point of view has undergone a change. Much interest is directed toward functional aspects that require reconstructive management. Whenever possible the integrity of joint play should be saved. Above all the metatarsophalangeal joint of the lesser toes is worth being preserved to prevent a severe disturbance of the biomechanics of the foot. Tendon transfers and subtle corrective osteotomies such as the Weil procedure allow restricting resection procedures to contraction deformities.

Arthroplasty↗

PubMed2003

Aspirin-responsive painful red, blue, black toe, or finger syndrome in polycythemia vera associated with thrombocythemia.

Five patients with red, purple blue, or black toes or fingers due to thrombocythemia associated with polycythemia vera (polycythemia and thrombocythemia vera) in four and essential thrombocythemia (thrombocythemia vera) in one are described. The microvascular erythromelalgic syndrome of thrombocythemia was overlooked and progressed to cold blue swollen and painful fingers or black toes in three patients with polycythemia and thrombocythemia vera due to arteriographically documented occlusions of digital or large peripheral arteries with no evidence of preexistent atherosclerotic vascular disease. Concomitant erythromelalgia of the hand palm could be confirmed by the histopathological findings of arteriolar thrombotic lesions in the reticular dermis in two patients with polycythemia and thrombocythemia vera. The increased hematocrit in the presented patients with polycythemia and thrombocythemia vera contributed to the progression of the microvascular syndrome of thrombocythemia to major occlusive ischemic events of the extremities. Standard therapy with oral anticoagulants and reduction of the hematocrit to normal by bloodletting did not affect the platelet-mediated microvascular erythromelalgic, ischemic symptoms in the patients with polycythemia vera because thrombocythemia vera persisted. Complete relief of pain and restoration of the ischemic acral circulation disturbances in patients with thrombocythemia vera or thrombocythemia associated with polycythemia vera in maintained remission by bloodletting could be obtained by long-term treatment with low-dose aspirin.

Aged↗

PubMed2004

Osteoid osteoma: painful enlargement of the second toe.

Osteoid osteomas involving the phalanges of the toes are a rare occurrence. We report a case of an osteoid osteoma of the distal phalanx of the second toe which was treated successfully with surgical excision. Although soft-tissue swelling with a typical clinical history is suggestive of the diagnosis, differentiation from subacute infection is subtle and may ultimately depend on tissue analysis.

Adolescent↗

PubMed2007

Superficial acral fibromyxoma of the toe, with erosion of the distal phalanx. A clinical report.

Superficial acral fibromyxoma (SAFM) is a rare soft tissue tumor most often located in the ungual region of the fingers and toes. This tumor was first described in 2001, and since then very few cases have been reported. We present the case of a 35-year-old male with a SAFM located in the toe, with involvement of the nail and erosion of the distal phalanx. The lesion was surgically removed, and the histopathological study confirmed the diagnosis of SAFM. The differential diagnosis must be established with other myxoid tumors and with those lesions showing a predilection for the distal portions of the limbs. After 2 years, the patient remains disease free, with no disability of any kind.

Adult↗