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At least 667 records · Page 37Linked to original sources
PubMed1998

Reconstruction of fingertip amputations by partial composite toe transfer with short vascular pedicle.

Five patients under 15 years-of-age, with a fingertip amputation through the nail plate, were treated with a custom-made partial toe transfer. Two of the patients had had previous attempts at surgical reconstruction using either a local flap or replantation. Delay between initial injury and reconstruction ranged from 2 to 60 days. In all cases the flap was harvested from the second toe. This "custom-made" compound transfer included the exact amount of pulp, nail bed and bone required for reconstruction. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a digital level on the recipient site. Good to excellent cosmetic results were obtained in all cases, with a nearly normal-looking fingertip. Duration of hospital stay ranged from 4 to 7 days. We recommend this technique for treatment of distal amputation close to the proximal nail fold, in young individuals.

Adolescent↗
PubMed2001

Adaptive changes in withdrawal reflexes after noxious stimulation at the heel and the toes in the decerebrated rabbit.

In decerebrated rabbits, reflexes evoked by electrical stimulation of the toes in the ankle flexor tibialis anterior were enhanced for > 30 min after application of 20% mustard oil to the base of the toes, whereas responses of the ankle extensor medial gastrocnemius to stimulation of the heel were depressed for > 20 min by the same stimulus. Applied to the heel, mustard oil had inconsistent effects on the flexor reflex but potentiated the extensor response for approximately 1 h. Intrathecal co-administration of naloxone (25 microg) with the selective alpha(2)-adrenoceptor antagonist RX 821002 (200 microg) enhanced both reflexes to more than twice pre-drug values and reduced or abolished all effects of mustard oil. These data confirm that the location of a noxious stimulus is an important determinant of the subsequent adaptive changes in reflexes, and indicate roles for endogenous opioids and noradrenaline in these processes.

Adaptation, Physiological↗
PubMed1998

Lumbar epidural block for 'painful legs and moving toes' syndrome: a report of three cases.

We report the effective use of epidural block in three patients with 'painful legs and moving toes' syndrome, which is characterized by involuntary movements of the toe (and sometimes of the foot) and excruciating pain in the leg. Several treatments had been unsuccessful in the management of the three patients reported including baclofen, benzodiazepines, carbamazepine and antidepressants. In two patients, lumbar sympathetic block was performed, the symptoms being alleviated temporarily in one patient. In contrast, injections of mepivacaine into epidural space suppressed pain and movements in all patients. In one patient, symptoms disappeared for many years after several epidural blocks. In the remaining two patients, epidural injections were repeated when the symptoms were severe.

Adult↗
PubMed1981

Reconstruction of severe transmetacarpal mutilating hand injuries by combined second and third toe transfer.

This paper reports on nine instances of combined second and third toe-to-hand transfers in eight patients for severe transmetacarpal mutilating hand injuries. In four cases, the transfer included an innervated flap from the fibular side of the great toe to provide sensibility to a previously constructed osteoplastic thumb. Prehensile function was significantly improved by providing chuck or tripod pinch as well as improved pulp-to-pulp and lateral pinch. At a mean follow-up of 20.3 months, there was only one failure.

Adult↗
PubMed1982

Digital reconstruction using the toe flap-- report of 10 cases.

The vascular-pedicle "wrap-around" free flap was used in five patients for reconstruction in amputations distal to the metacarpophalangeal joint. In five other patients who had normal thumbs but had lost all fingers, the technique was expanded to include the second toe with great toe wrap-around flap. All patients did well, but significant bone peg resorption occurred in six patients and in three others the bone peg fractured.

Amputation, Traumatic↗
PubMed1983

Keys to successful second toe-to-hand transfer: a review of 30 cases.

Thirty cases of second toe-to-hand transfers are reported in which there were no failures. Factors judged to be important in these successful results include the careful choice of the donor site, distal to proximal exposure of first metatarsal artery, ensuring adequate perfusion of the toe before severing its vessels, and meticulous postoperative care.

Amputation, Traumatic↗
PubMed1983

Microsurgical transfer of the great toe to the radius to provide prehension after partial avulsion of the hand.

Transfer of the great toe to the radius proved to be an effective means of gaining the function of grasp in a patient with an incomplete amputation of the hand in which all the digital flexor tendons had been avulsed. The remaining stump consisted of the carpal bones and fragments of the second, third, and fourth metacarpals. A long, oblique osteotomy of the first metatarsal was designed so that it would abut with the palmar face of the radius. Power was supplied to the great toe by the flexor carpi radialis and the brachioradialis tendons. Sensibility was supplied by the median nerve and circulation was furnished by the radial artery and the cephalic vein.

Adult↗
PubMed2001

In vivo magnetic resonance micro-imaging of the human toe at 3 Tesla.

The feasibility of in vivo high-resolution magnetic resonance micro-imaging of fine anatomic structures of human toes was tested. Five healthy subjects were investigated on an experimental 3 Tesla whole body scanner, using standard 3D gradient echo sequences. A radio-frequency surface coil was used for signal detection. Feet, toes and surface coil were comfortably fixed using a home built device for positioning and reduction of motion artifacts. The spatial resolution of 117 x 313 x 375 microm(3) allowed detailed visualization of anatomic structures like skin layers, vessels and nerves. In addition, oval structures with diameters ranging from 500 to 1000 microm were observed in all subjects, which could represent the sensory nerve endings of Vater-Pacinian bodies. Thus, high resolution MR micro-imaging at 3 Tesla may provide improved morphologic information in distal extremities of humans in vivo.

Adult↗
PubMed1996

Value of toe pulse waves in addition to systolic pressures in the assessment of the severity of peripheral arterial disease and critical limb ischemia.

PURPOSE: Although pressure measurements are useful in the assessment of the severity of the arterial obstruction, they do not completely identify limbs with and without critical limb ischemia. Our objective was to test whether addition of the measurements of toe pulse waves (PW), which depend on distal perfusion, to pressure measurements could improve the determination of the severity of arterial disease and the presence of critical limb ischemia. METHODS: We measured toe pressure (TSP) and ankle/brachial index (ABI) and recorded PW with photoplethysmography in 358 limbs of 182 patients. RESULTS: TSP, ABI, and PW amplitude were lower in 67 limbs with rest pain, skin lesions, or both, with mean differences of 29 mm Hg, 0.12, and 16 mm, respectively (p < 0.01). Similarly, in the subgroup of 107 limbs with TSP < or = 30 mm Hg, TSP, and PW amplitude, but not ABI, were lower in 53 limbs with rest pain, skin lesions, or both, with mean differences of 10 mm Hg and 7 mm (p < 0.01). Multiple logistic regression showed that after controlling was done for TSP and ABI, the odds ratio for the presence of rest pain, skin lesions, or both associated with PW amplitude < or = 4 mm was 4.3 (95% confidence interval 1.7, 11.0; p < 0.01). In the subgroup with TSP < or = 30 mm Hg, this odds ratio was 3.5 (95% confidence interval 1.0, 11.6; p < 0.05). CONCLUSIONS: The findings indicate that addition of PW recording to pressure measurements is likely to increase the accuracy of assessment for critical limb ischemia.

Aged↗
PubMed2003

Toe-to-hand transplantation.

In the mutilated hand microsurgical toe-to-hand transplantation provides thumb and finger reconstruction that is superior to conventional techniques in appearance and function. Hand reconstruction using toe transplantation should be individually planned and carefully executed to obtain optimal results and minimal disability in the donor foot.

Amputation, Traumatic↗
PubMed1991

[A new test for the functional evaluation of the hand and its contribution to the study of toe transfers: the 5 matches test called "Take Five"].

After studying a series of thumbs reconstructed by 2nd toe transfer, we devised a new dexterity test: the "five matches test" or "Take Five Test" (R.S.). This test consists of the standardised timed and comparative pick-up of 5 identical fine objects (matches), permitting a simple and quick evaluation which objectively quantifies dexterity in fine pinches. The specificity of our test is that it is bilateral and comparative providing a narrow range of normality. In fact, a marked variability of time-scores is found between different individuals of a normal population, making it difficult to determine a "normal dexterity" criterion. But in the same person, there is little variability between two successive experiments or between the dominant and non-dominant hands. Examining a reconstructed hand, we have chosen as the "normal dexterity" criterion the time-score of the contralateral spared hand, timed first. The final score (from 0 to 4 points) is based on the difference between time-scores of the 2 hands (delay tested hand/spared hand). The "Take Five Test" (five matches pick-up test) has largely proven its efficiency in studying a series of thumbs reconstructed by 2nd toe transfer (operated on by V.M.). Fine pinch dexterity is satisfactory in 45% of cases (65% when long digits are spared), scoring at least 2 points (delay less than 4 seconds). The average score is 1.6 pts (range: from 0 to 4). This test could prove the functional value of parameters such as phalangeal mobility and a short delay between injury and reconstruction.

Adolescent↗
PubMedDate not supplied

Current concepts of toe-to-hand transfer: surgery and rehabilitation.

Optimal functional recovery after toe-to-hand transfer depends on skillful surgery as well as aggressive motor and sensory rehabilitation. The patient should be well motivated and willing to incorporate the involved hand in daily living and carry out the rehabilitation program on a daily basis. This article presents the current recommendations for the different toe-to-hand transfers and their postoperative rehabilitation programs.

Finger Injuries↗
PubMed2000

Blue toe syndrome: treatment with intra-arterial stents and review of therapies.

PURPOSE: To determine if intra-arterial stent placement can adequately treat lesions producing microemboli to the lower extremities. MATERIALS AND METHODS: During a 6.5-year period, 15 patients presenting with blue toe syndrome had 16 presumed embolic lesions treated with intra-arterial stents. These patients were evaluated during routine clinical follow-up during a 6-month period. This evaluation included physical and noninvasive arterial examinations. When patients could not return for follow-up, hospital, clinical, vascular laboratory, and radiology records were reviewed to assemble the appropriate information. Outcomes included symptoms of recurrent emboli, amputation, and death. RESULTS: Treated embolic lesions included two aortic stenoses, three bilateral iliac artery stenoses, nine unilateral iliac artery stenoses (one patient received separate treatment of unilateral iliac lesions), and two superficial femoral artery stenoses. Patients were followed-up for a mean of 18 months. Eight of 15 patients (53%) were improved or stable without complications. There were eight negative outcomes experienced in seven patients. Three patients (20%) were deceased at follow-up. Four patients (27%) had undergone amputation; one transmetatarsal amputation and three below-the-knee amputations. Only one of these was related to progressive disease in the treated extremity (7%). One patient (7%) experienced recurrent embolic symptoms. Stents were patent in all patients. CONCLUSION: Patients with blue toe syndrome are at high risk of limb loss and mortality despite treatment. Intra-arterial stent placement provides an alternative to standard surgical treatment. Further studies are needed to define the optimum therapy.

Adult↗
PubMed1997

Blood flow rate during orthostatic pressure changes in the pulp skin of the first toe.

OBJECTIVES: Determination of the local regulation of cutaneous blood flow through nutritive capillaries and through arteriovenous anastomoses of the pulp of the first toe in response to passively induced orthostatic blood pressure changes in normal subjects and in patients with occlusive atherosclerotic disease. MATERIAL: Six normal subjects, seven patients with unilateral, crural intermittent claudication and six patients with unilateral, chronic critical ischaemia. METHODS: Blood flow rates were measured in supine subjects by the heat washout method (the sum of blood flow rate in arteriovenous anastomoses and blood flow rate in nutritive capillaries) and by the 133Xenon washout method (blood flow rate in nutritive capillaries) after local, atraumatic labelling. Measurements were made with (a) the toe passively elevated to 50 cm above heart level, (b) at heart level and (c) passively lowered to 50 cm below heart level. RESULTS: Autoregulation of nutritive blood flow was present in normal subjects and in claudicants, but the local sympathetic veno-arteriolar axon reflex was absent in both groups. In patients with critical ischaemia blood flow rate was the same in the supine position and during lowering in arteriovenous anastomoses and in nutritive capillaries. The arteriovenous anastomoses had distinct and characteristic reaction patterns in response to lowering in each of the three examined groups and to elevation in normal subjects and in patients with intermittent claudication (not measured in patients with critical ischaemia). CONCLUSIONS: The microvascular responses to changes of orthostatic blood pressure differed among the three groups (normal subjects, patients with intermittent claudication, patients with critical chronic leg ischaemia). The heat washout method may be used to detect the functional significance of occlusive atherosclerotic disease.

Adult↗
PubMed1989

Effect of postural change and thermoregulatory stress on the capillary microcirculation of the human toe.

1. We have applied the technique of television capillary microscopy to make direct measurements of nutritional capillary flow in the toe nailfold (i) at heart level and (ii) in a near standing position, with the foot 96 cm below heart level. By indirect heating we have examined the relationship between posture-related changes and thermoregulation in the capillary circulation of the toe. 2. Capillary blood flow in 14 male subjects with their feet at heart level showed a positive correlation with increasing skin temperature. 3. On quiet standing, capillary blood flow decreased to 11.3% of supine values, achieved both by a reduction in capillary blood velocity and the duration of flow. 4. Indirect heating of the trunk led to a partial release of sympathetic tone and induced a significant increase in capillary blood flow in both the supine and dependent positions. However during heating, the percentage fall in capillary blood flow associated with dependency remained unchanged. 5. In conclusion, it appears that in the dependent foot, compensatory mechanisms exist to limit nutritional capillary blood flow by regulating both erythrocyte velocity and the duration of flow. These mechanisms fulfil a physiological requirement to limit the rate of oedema formation. The preservation of this response during the partial sympathetic release induced by indirect heating suggests a mechanism independent of that controlling flow through arteriovenous shunts. Our results are compatible with the hypothesis that a local vasoconstrictor mechanism is operative in the vascular resistance elements in closest relation with the capillary bed, and distal to that regulating arteriovenous shunt flow.

Adult↗
PubMed1999

Relationship between stimulating current and accelographic train-of-four response at the great toe.

We investigated the accelographic train-of-four response evaluated at the great toe at varying stimulating currents. Fifteen adult patients undergoing elective general anaesthesia were studied. The mean current at which a supramaximal T1 value could be elicited was > 49 (9) mA [mean (SD)]. Ratios of accelographic T1 values at 50, 40, 30, 20 and 10 mA to accelographic T1 value at 60 mA were 0.90 (0. 18), 0.58 (0.37), 0.38 (0.37), 0.19 (0.26) and 0.00 (0.00), respectively [mean (SD), p < 0.05 for 50 mA vs. 30, 20 and 10 mA, p < 0.05 for 40 mA vs. 20 and 10 mA, and p < 0.05 for 30 vs. 10 mA]. Threshold currents for train-of-four (the lowest currents at which any train-of-four response could be elicited) before and after induction of anaesthesia were 30 (10) and 31 (10) mA, respectively. The train-of-four ratio (T4/T1) measured at varying currents did not differ significantly. However, in the patients in whom threshold currents for train-of-four were 40, 30 and 20 mA, the train-of-four ratio recorded at the threshold current was significantly less than at 50 mA. We conclude that at the great toe, the mean current at which a supramaximal response to train-of-four can be yielded is as high as > 49 mA. The mean threshold currents for TOF before and after induction of anaesthesia were 30 and 31 mA, respectively. Train-of-four ratio measured at the threshold current is less than that at 50 mA.

Anesthesia, General↗
PubMed2002

Fungal flora of human toe webs.

A total of 100 young adults (67 males and 33 females) participated in the study. Clinical evaluation showed that only 10 of the volunteers showed some scaling, fissuring and peeling of the toe webs. Four of these complained of occasional itching. Fourteen different genera of fungi were recovered from 78 of the 100 youths screened. Yeasts were recovered from 21 (27%) of the positive cases, nondermatophytes from 38 (49%) and dermatophytes from 19 (24%). Microsporum gypseum was the most commonly recovered dermatophyte. Rhizopus stolonifer and Trichosporon cutanueum were the most frequently recovered nondermatophytic mould and yeast, respectively. More males (62.8%) harboured these organisms than females (37.2%). The study further showed that human toe webs that are apparently healthy harbour a variety of fungi, that may be potential pathogens.

Adolescent↗
PubMedDate not supplied

The effect of first metatarsophalangeal arthrodesis on transverse plane deviation of the second toe: a retrospective radiographic study.

The purpose of this retrospective, radiographic study was to examine the effect of first metatarsophalangeal arthrodesis on the transverse plane deviation of the second metatarsophalangeal joint. Sixty-nine patients (76 feet) were separated into 3 groups based on preoperative diagnosis: group 1, hallux valgus; group 2, hallux rigidus; and group 3, rheumatoid forefoot deformity with concomitant lesser metatarsal head resection. Intermetatarsal, hallux abduction, and second metatarsophalangeal angles were measured on preoperative and follow-up anteroposterior radiographs. Multivariate analysis found a significant postoperative change (P < .001) in both the intermetatarsal and hallux abduction angles for all groups, but no significant change in the second metatarsophalangeal angle for any group. There was also no significant difference in the number of patients with medial versus lateral second toe deviation in each group. The addition of a second ray procedure, such as a digital arthrodesis or second metatarsal decompression osteotomy, in groups 1 and 2 did not correlate to the amount of change in second metatarsophalangeal deviation. However, there was a significant correlation (r = .330; P = .004) between the amount of change in the hallux abduction angle and the amount of change in the second metatarsophalangeal angle. A lack of change in the second metatarsophalangeal angle in patients with hallux valgus and hallux rigidus suggests that the creation of a stable medial buttress may protect the lesser digits. However, in patients with rheumatoid, this lack of change denotes a postoperative recurrence of lateral deviation of the second toe despite lesser metatarsal head resection and stabilization of the hallux.

Adult↗