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At least 685 records · Page 38Linked to original sources
PubMed2002

Outcomes of multiple microvascular toe transfers for reconstruction in 2 patients with digitless hands: 2- and 4-year follow-up case reports.

Two farmers who sustained amputations of all digits in the dominant hand had hand reconstructions with 3 toes from both feet. Both patients were monitored with hand function tests and validated outcomes questionnaires (Michigan Hand Outcomes Questionnaire and Short Form-36). Long-term follow-up data showed that both patients were able to use the reconstructed hands for activities of daily living and heavy manual farm labor. Until the immunologic problems associated with hand transplantation are solved, multiple toe transfer for total hand reconstruction is a reliable surgical treatment for these patients.

Activities of Daily Living↗
PubMed1999

Double second toe transfer in congenital hand anomalies.

A series of 14 patients with congenital hand anomalies who received staged double second toe transfers to the same hand for restoration of function or form were reviewed retrospectively. There were three children with constriction ring syndrome, two with symbrachydactyly and nine with transverse absence (failure of formation). There were different indications, technical difficulties and results with the various anomalies. All transferred toes were mobile and sensate, and were reported to be of benefit in both function and appearance. However, secondary surgical procedures were required in all patients.

Adolescent↗
PubMed1999

Free toe pulp transfer for digital reconstruction after high-pressure injection injury.

We report two cases of high-pressure injection injuries to the fingertip in which free toe pulp flaps were used to resurface the palmar surface of the finger following extensive wound debridement. There was good return of sensibility and, because of the high durability of the donor skin, both patients regained good functional use of the injured digits and returned to heavy manual work. There was minimal associated morbidity of the donor sites. The free toe pulp flap represents an excellent alternative for resurfacing the digit with a large residual skin defect after high-pressure injection injury.

Accidents, Occupational↗
PubMed2002

The arterial system of the first intermetatarsal space and its influence in toe-to-hand transfer: a report of 53 long-pedicle transfers.

A study of the arterial system in the first intermetatarsal space was performed during 53 toe-to-hand or vascularized tissue of the toe transfers with long arterial pedicles. The first dorsal metatarsal artery was used as a single pedicle in 25 transfers and the first plantar metatarsal artery in 21: both arteries were taken simultaneously in seven transfers. In 11 transfers, the dorsalis pedis artery and the perforating branch were absent, although this did not exclude the presence of a first dorsal metatarsal artery which arose from the plantar system by means of an ascending vascular branch in seven cases.

Adolescent↗
PubMed2005

[Experiences with the Butler procedure for overlapping fifth toe].

UNLABELLED: Overlapping fifth toe is a finding in pediatric orthopaedics which rarely requires operative therapy. PATIENTS AND METHOD: Between Jan. 1, 1992 and Dec. 31, 2002 five operations of an overlapping fifth toe using the Butler procedure were performed at a mean patients age of 5.5 years (min: 3, max: 9). All patients were clinically evaluated after a mean follow-up of 6 years (min: 2, max: 10) according to the score of Black. We present the technique of the Butler procedure and discuss the relevant literature. RESULTS: An excellent result was achieved in all patients. Despite the extensive soft tissue release no complications could be found. CONCLUSION: The Butler procedure is a simple and safe procedure without any need of immobilisation.

Arthroplasty↗
PubMed2006

[Pernio as cause of a blue toe syndrome].

The evaluation of a blue toe syndrome in children is a diagnostic challenge. The differential diagnosis includes pernio (chilblains) if all diagnostic tests are negative and a corresponding anamnesis is presented. In this report we illustrate the case of a 7 1/2- year-old girl who presented with two blue toes and discuss differential-diagnostic considerations.

Biopsy↗
PubMed2000

Combined free toe and free deep inferior epigastric perforator flap for reconstruction of the thumb and thumb web space.

To repair a complexly injured hand with composite loss of the thumb and the thumb web space in one stage, the combined transfer of a free second toe and a free deep inferior epigastric perforator flap was designed. It was used to simultaneously reconstruct the thumb and thumb web space of the injured hand in five cases. All flaps survived and there were no complications at any donor site after the reconstructions. In follow-up averaging 35.6 months, the final functional and cosmetic outcomes of the reconstructed thumbs and thumb web spaces were satisfactory. Results demonstrated that the combined transfer of a free second toe and a free deep inferior epigastric perforator flap is a valid method for simultaneous reconstruction of the thumb and the thumb web space of the injured hand.

Abdominal Muscles↗
PubMed1999

Dorsolateral toe flap as a neurovascular graft carrier in finger reconstruction.

Simultaneous finger nerve and artery grafting, and soft-tissue coverage with a dorsolateral toe flap, including a plantar digital neurovascular bundle, were performed in a single patient. Although only fair sensory recovery was achieved, due to complicated wound healing, the toe flap as a neurovascular graft carrier can be a treatment of choice for reconstructing complex finger palmar defects.

Adult↗
PubMed1993

Toe-to-thumb transplantation in the rat.

A toe harvested from the hind foot of a rat was successfully transplanted to the rat thumb position, with vessel and nerve anastomoses. With this technique practiced, there will be more ease, confidence, and success when doing toe-to-hand or small tissue transplantations or replantations in humans, even in infants. The procedure is described and discussed.

Animals↗
PubMed1988

Aesthetic reconstruction of long fingers with toe-to-hand transfer.

This paper reports experiences of 67 toe-to-hand transfers. Success was achieved in all cases. Six cases are discussed that deal with the less investigated problem of long finger reconstruction. Amputation injuries of long fingers through the metacarpus are difficult problems. A determining principle of their restoration consists of the creation of adequate toe length for transfer and correction of biomechanic hyperextension. The report also highlights the advantages of metacarpal reconstruction with the "brass-knuckle" procedure, as the best technique for this type of injury. Aesthetic and functional advantages after such long finger reconstruction and psychological recovery of the patient seem worthy of emulation.

Adult↗
PubMed1984

Reconstruction of the thumb by free skin flap of the big toe.

Experience with 12 cases of thumb reconstruction is reported, utilizing a free skin flap from the big toe and remodelled iliac bone graft, to create metacarpal and phalangeal configuration. Results show that the reconstructed thumbs have good functional recovery, cosmetic appearance, and varying degrees of sensation. The procedure preserves the big toe of the donor foot and produces minimal impairment.

Amputation, Traumatic↗
PubMed1995

Short fourth toes in Rett syndrome: a biological indicator.

Classic Rett syndrome is now well-known as a non-dysmorphic developmental disorder almost certainly of genetic origin. Short 4th toe (uni- or bi-lateral) is inherited as an autosomal dominant with 27% penetrance and is found also in certain dysmorphic syndromes. Having observed the anomaly in several Rett cases, we examined a cohort of classic Rett people at advisory clinics and all the residents in an adult learning disabled hospital in order to determine the significance of the association. Among the Rett clinic group 28 of 137 showed the anomaly (20%). Among the heterogeneous hospital group it was found in 19 of 526 people, 9 of 206 females (4%) and 10 of 320 males (3%). Rett syndrome was present in 7% of all the women (14 of 206 women). Four of the Rett women showed the toe anomaly (28% of the Rett cases). The anomaly was found in 4 men and 4 women with Down syndrome, representing 16% (8 of 49). Diagnoses in other men with the anomaly included foetal alcohol syndrome, toxoplasmosis, 18/2 translocation and birth injury. The only other woman with the anomaly was profoundly disabled with short limbs. The strong positive association of the anomaly with Rett syndrome and Down syndrome throws new light on the developmental processes affected by these diseases.

Brain↗
PubMed1988

[Silicone implants of the basal joint of the big toe. A critical 10-year study].

Long-term clinical results with Swanson silastic replacements of the basal joint of the big toe 10 to 16 years after surgery are presented. Among the 60 clinically and radiologically re-examined joints there was a striking discrepancy between subjective satisfaction and objective radiologic findings. In some cases pronounced wear of the metatarsal capitulum was seen, with synovitis of varying degrees of clinical severity. The continued use of silicone implants to replace the basal joint of the big toe can only be recommended if radiologic follow-up examinations are performed more frequently. The results of the ten-year study presented here must be taken into account in patient counselling concerning surgery.

Adult↗
PubMed1990

[Osteoid osteoma at the end of the phalanx of the big toe].

A 20-year-old man with persistent pain in the left big toe associated with broadening, thickening and discolouration of the toenail had been treated unsuccessfully for 21 months by surgical measures (wedge excision, avulsion of the nail) and local applications (antibiotics, antimycotics, disinfectants). A radiograph of the left big toe showed an area of calcification 0.5 cm in diameter at the base of the terminal phalanx. It was surrounded by a narrow zone of transradiancy and projected upwards above the margin of the bone. Among the diagnostic possibilities were osteomyelitis and osteoid osteoma. Biopsy revealed the latter, and the patient was cured by "en bloc" resection of the tumour. This case shows that abnormalities of nail growth of the kind commonly associated with paronychia may occasionally be due to a neoplastic lesion in the terminal phalanx.

Adult↗
PubMed2001

Gram-negative bacterial toe web infection: a survey of 123 cases from the district of Cagliari, Italy.

BACKGROUND: Foot intertrigo is mostly caused by dermatophytes and yeasts, less frequently by gram-positive and gram-negative bacteria. Nevertheless, the importance of polymicrobial infections and especially colonizations of Pseudomonas aeruginosa can cause therapy problems in relation to antibiotic resistance and the risk of potentially lethal complications. OBJECTIVE: The aim of this study was to evaluate the main epidemiologic and clinical features of intertrigo from gram-negative bacteria, the function of promoting factors, and the measures taken to treat and prevent this disorder. METHODS: Between 1989 and 1998, 123 cases of intertrigo from gram-negative bacteria were observed at the Cagliari University Dermatology Department. Routine clinical and blood examinations, repeated bacterioscopic and mycologic examinations, cultures aimed at identifying the responsible bacteria, and antibiograms were performed. RESULTS: P aeruginosa was found to be the prevailing pathogen, both alone and associated with other gram-negative bacteria (such as Escherichia coli, Proteus mirabilis, Morganella morganii) and gram-positive bacteria. Clinical manifestations were similar in the majority of patients: erythema, vesicopustules, erosions, and marked maceration caused by abundant, malodorous exudate. Lesions affected the interdigital spaces of both feet and frequently extended to the planta and the back of the toes. Patients complained of burning and pain. Successful therapies were achieved with combined topical and systemic treatment; to avoid the risk of antimicrobial resistance, the choice of the active antibiotic was guided by antibiograms. CONCLUSION: In all symptomatic toe web infections, the presence of gram-negative germs, such as P aeruginosa, should be investigated to avoid the risk of treatment failures and more severe local or systemic complications.

Administration, Topical↗
PubMed1985

Infrapopliteal bypass for established gangrene of the forefoot or toes.

This study was undertaken to assess factors affecting limb salvage after femorodistal bypass in patients with established gangrene. From January 1977 through June 1983, 361 patients underwent infrapopliteal bypasses; 58 patients (59 limbs) had forefoot and/or toe gangrene. There were 33 men and 25 women (mean age 67.6 years), and 40 patients (69%) were diabetic. A total of 71 femorodistal bypass procedures were performed in these patients: a single bypass in 49, repeat procedure in eight, and multiple bypasses in two patients. Graft material was autogenous saphenous vein in 22 cases, polytetrafluoroethylene (PTFE) in 39 cases, and a composite graft in 10 procedures. After bypass 50 patients underwent limited toe or forefoot amputation with uncomplicated healing. Limb salvage by life-table analysis was 70% at 1 year, 60% at 3 years, and 28% at 5 years. The graft patency at 3 years was 65% for vein grafts and 30% for PTFE grafts. In the entire series the operative mortality rate was 1.7%. Age, sex, hypertension, or diabetes mellitus did not influence the result of surgery. Similarly, failure of a previous femoropopliteal or tibial graft did not reduce the likelihood of limb salvage. Graft patency, however, is prerequisite for limb salvage, and graft patency can be maintained by thrombectomy or repetitive bypass. The present study suggests that limb salvage is possible in as many as two thirds of limbs with established gangrene. Although saphenous vein remains the graft material of choice, its absence should not preclude attempts at limb salvage. Repetitive grafting did not jeopardize patient safety but contributed significantly to extended limb survival.

Actuarial Analysis↗
PubMed2002

Toe tissue transfer for the reconstruction of digital injuries.

Based upon the reconstructive principle "Replace like with like", the first and the second toes have shown to be ideal to replace lost digital structures in congenital cases or in traumatic cases when reimplantation has failed. The aim of this paper is to present a series of 15 patients operated on in our department between 1988 and 1995. In this series, the value of toe transfer for replacement of lost digital structures is illustrated and critically analysed by means of the final functional result evaluation.

Adolescent↗