SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The foot is an invaluable bank of spare parts available for reconstructing the mutilated hand. The dorsalis pedis flap, the extensor digitorum brevis muscle, and the first and second toes can now be used as free transfers. We believe that partial toe transfers, including either sensitive cutaneous flaps or composite tissue, are also extremely useful in properly selected patients.
The hook nail deformity is caused by loss of fingertip bone and soft tissue. Healing can result in a volarly displaced distal nailbed and a tight tip with inadequate padding and a poor cosmetic appearance. A composite graft from the second toe placed beneath the released nailbed gives good support and improved pulp substance. The technique of the composite toe graft has been performed in nine patients. All grafts were 100 percent viable, but one patient required a second graft for additional tip bulk. There has been no donor-site morbidity in the follow-up of 1 month to 2 years.
A retrograde approach to dissection of the vascular pedicle in toe-to-hand transfer is presented, along with a simplified view of the vascular anatomy of the first web space. This approach has several advantages. First, the dominant vascular supply to the toe is elucidated early in the procedure, allowing for less unnecessary dissection of an inadequate pedicle. This also eliminates the need for preoperative arteriography. Furthermore, in cases where a lengthy pedicle is not required, retrograde dissection dispenses with harvest of a proximal vessel, which will not be needed for the transfer, and destructive dissection of the foot can be minimized.
Metacarpal hand refers to the hand that has lost its prehensile ability through amputation of all fingers with or without amputation of the thumb. Functional restoration can be achieved by a wide variety of microvascular toe transfer techniques. When deciding which procedure should be used, careful consideration must be given to the level of amputation of the fingers as well as the functional status of the remaining thumb. In this article we propose a classification for the various patterns of the metacarpal hand along with guidelines for selection of the proper toe transfer procedure.
Utilizing the tissue obtained from the plantar surface (metatarsophalangeal-distal interphalangeal region) of the second toe is an ideal procedure for reconstruction of partial finger tissue defects. The major advantage of this method is that it provides satisfactory aesthetic and functional improvement at the recipient site: furthermore, good results from the aesthetic point of view and minimum morbidity at the donor site are obtained. Our procedure utilizes the free neurovascular skin flap (second toe plantar flap) and full-thickness skin graft. As for the free flap, artery and nerve are obtained from the plantar neurovascular bundle and vein from the dorsal or plantar vein. All cases reconstructed with this procedure revealed satisfactory sensory restoration and aesthetic appearance. The donor sites also revealed no contracture and visible scar. In this paper, we discuss the application of this procedure for finger tissue reconstruction.
The therapy for congenital hand malformations, especially in symbrachydactyly and constriction ring syndromes, is challenging. Between 1975 and 1995, 20 children with congenital hand deformities underwent reconstruction by 56 nonvascularized free toe phalanx transfers. The average age at initial surgery was 4.8 (range, 0.5 to 22) years. Retrospectively, the children were examined after an average of 3.5 (range, 1.5 to 17.6) years for function of the hand, transplanted phalanx growth, assessment for the epiphyseal plate, and assessment for psychologic performance with their parents. Donor-site morbidity was determined according to measured growth deficit, observing the child's gait, and toe function. In the younger patients (up to 1.5 years), the grafts were well tolerated and showed good growth and only few resorptions. In the age group from 1.5 to 4 years, the grafts showed no growth. In the age group older than 4 years, the grafts were mostly resorbed. The clinical reexamination revealed in most cases only passive motion in the joints, but the function of the hand was improved, with only few problems of the donor site. Most patients and their parents reported a positive effect of the phalanx transfer.
A painful neuroma in the amputation stump of a finger can be psychologically and physically disabling. Numerous surgical procedures have been attempted to prevent and treat amputation neuromas of the finger, but the results are inconsistent. Microsurgical transfer of the distal second toe to the amputated stump of the finger can provide a pathway and target for the regenerating axons and avoid recurrence of neuromas. In this article, we present the experience of successful treatment of amputation neuromas of an index finger with microsurgical distal toe transfer.
Outcomes from observation or cast or surgical treatment of idiopathic toe-walking were determined in 136 children. With patient-determined outcomes, for the observation group, gait was normal in 6%, improved in 45%, and unchanged in 49%. Physician-determined outcomes demonstrated normal gait in 12% of children. Outcomes were similar in the cast group. With patient-determined outcomes in the surgical group, 22% walked normally, 50% had improved, 26% were unchanged, and 2% had deteriorated; with physician-determined outcomes, 37% walked normally. The natural history, determined from the observation group, was for idiopathic toe-walking to persist, albeit with improvement in 50%. Cast treatment did not alter the natural history. Surgical treatment may influence the outcome, but indications for surgery need to be clarified.
A simple new method for the treatment of ingrown toe-nails was devised and applied to 33 toe-nails in 22 patients. The entire nail surface, except for the margin, was abraded until the nail became flexible with a Schreu's skin grinder equipped with a steel bar. When there was infection or granulation of the nail wall, the imbedded nail corner was trimmed before abrasion. The patients underwent additional treatments when one treatment was not enough to achieve cure or when discomfort appeared, which was the first symptom of recurrence. The average number and duration of treatments was 2.9 times and 16 months, respectively. Relief from pain occurred in all patients soon after abrasion was performed. Recurrence of infection and granulation was observed in only one patient. Five patients (23%) remained problem-free for more than one year without any additional treatment, because their incurved nail was gradually improved in shape by repetition of this procedure. This therapy was particularly effective in patients with severely incurved nails.
We report a case of Churg-Strauss syndrome (CSS) with necrosis of the fingers and toes and liver infarction. A 59-year-old man with asthma suddenly noticed that his fingers and toes felt unusually cold. This condition worsened progressively, and some digits became necrotic within several weeks. Laboratory studies revealed hypereosinophilia and an extremely elevated serum level of IgE. Digital subtraction angiography of the extremities revealed extensive irregular narrowing of small and medium-sized arteries in the extremities. Abdominal computed tomography (CT) revealed an area of low density at the periphery of the right lobe of the liver. Angiography revealed irregular narrowing of small arteries that corresponded to the ischemic area. A nerve conduction study suggested sensory nerve neuropathy. The preceding asthma, acute onset of digital necrosis, liver infarction, neuropathy, and hypereosinophilia strongly suggested a diagnosis of CSS. The patient was treated with 40 mg of prednisolone and 120 micro g of intravenous prostaglandin E1 daily, and all the digits that had turned black and necrotic were amputated. After the amputation, the dose of prednisolone was gradually reduced, and no new lesions appeared on the skin or in the liver. The rare possible complications of CSS, including necrosis of digits and liver infarction, should not be ignored.
Subungual exostosis is a benign osteocartilaginous tumor of the ungual apparatus, particularly of the toes. It affects both sexes equally, more frequently in the second and third decades of life. We describe a 6-year-old girl who came to our attention because of the enlargement of a pinkish nodule in the distal part of the nail bed of the first toe, progressively elevating the nail plate. History, X-ray imaging and histopathologic examination led us to confirm our clinical suspicion, excluding any other possible cause of the subungual mass. The peculiar features of this clinical entity, and the possibility of effective treatment by practical surgical techniques, are discussed.
INTRODUCTION: The aim of this study was to observe the outcome of patients with a great toe pressure (GTP) reading of less than 40 mmHg. METHODS: Between 2002 and 2004, of 4,714 patients assessed in the Westmead Vascular Laboratory, 365 (7.7%) had GTP measurements for assessment of possible critical limb ischaemia. There were 56 limbs in 40 patients with a GTP measurement of less than 40 mmHg, and this group was studied to assess outcome factors of death, requirement for major or minor amputation, arterial reconstructive surgery, clinical stability, or documented improvement from the initial assessment. RESULTS: Patients requiring a major amputation had an average GTP of 13 mmHg and a toe brachial index (TBI) of 0.08, whereas those not undergoing a major amputation had an average GTP of 23.6 mmHg and TBI of 0.15. This association was weaker when an initial single evaluation was used as opposed to two or more serial assessments. Patients with and without a major amputation had an average ankle brachial index of 0.16 and 0.53, respectively. Diabetes mellitus requiring insulin and cerebrovascular disease were risk factors for major amputations. CONCLUSIONS: Low GTP was associated with a greater risk of major amputations. Two or more serial assessments were found to be of greater value than an initial single assessment.
For many years, death implied immobility. Nevertheless, there are anecdotal reports of spontaneous or reflex movements (SRMs) in patients with Brain death (BD). The presence of some movements can preclude the diagnosis of BD, and consequently, the possibility of organ donation for transplantation. McNair and Meador [(1992), Mov Dord7: 345-347] described the presence of undulating toe flexion movements (UTF) in BD patients. UTF consists in a sequential brief plantar flexion of the toes. Our aim was to determine the frequency, characteristics and predisposing factors of UTF movements in a prospective multicenter cohort study of patients with BD. Patients with confirmed diagnosis of BD were assessed to evaluate the presence of UTF using a standardized protocol. All patients had a routine laboratory evaluation, CT scan of the head, and EEG. Demographic, clinical, hemodynamic and blood gas concentration factors were analyzed. amongst 107 BD patients who fulfilled the AAN requirements, 47 patients (44%) had abnormal movements. UTF was observed in 25 (23%) being the most common movement (53%). Early evaluation (OR 4.3, CI95% 1.5-11.9) was a predictor of UTF in a multivariate regression model. The somato-sensory evoked potential (SSEPs) as well as brainstem auditory evoked potentials (BAEPs) did not elicit a cortical response in studied patients with UTF. This spinal reflex is probably integrated in the L5 and S1 segments of the spinal cord. Abnormal movements are common in BD, being present in more than 40% of individuals. UTF was the most common spinal reflex. In our sample, early evaluation was a predictor of UTF. Health care professionals, especially those involved in organ procurement for transplantation, must be aware of this sign. The presence of this motor phenomenon does not preclude the diagnosis of BD.
1. While it is known that the average firing rate of a population of motoneurones declines with time during a maximal voluntary contraction, at least for many muscles, it is not known how the firing patterns of individual motoneurones adapt with fatigue. To address this issue we used tungsten microelectrodes to record spike trains (mean +/- s.e.m., 183 +/- 27 spikes per train; range, 100-782 spikes) from 26 single motor units in extensor hallucis longus during sustained (60-180 s) maximal dorsiflexions of the big toe in seven human subjects. 2. Long spike trains were recorded from 13 units during the first 30 s of a maximal voluntary contraction (mean train duration, 9.6 +/- 1.2 s; range, 3.6-21.9 s) and from 13 units after 30 s (mean train duration, 16.6 +/- 3.7 s; range, 7.1-58.1 s). Maximal isometric force generated by the big toe declined to 78.3 +/- 6.3 % of its control level by 60-90 s and to 39.5 +/- 1.4 % of control by 120-150 s. Despite this substantial fatigue, mean firing rates did not change significantly over time, declining only slightly from 15.8 +/- 0.7 Hz in the first 30 s to 14.0 +/- 0.5 Hz by 60-90 s and 13.6 +/- 0.3 Hz by 120-150 s. 3. To assess fatigue-related adaptation in discharge frequency and variability of individual motor units, each spike train was divided into 2-15 equal segments containing at least 50 interspike intervals. Discharge variability was measured from the coefficient of variation (s.d. /mean) in the interspike intervals, with the s.d. being calculated using a floating mean of 19 consecutive intervals. Adaptation was computed as the average change in firing rate or variability that would occur for each 1 s of activity. There were no systematic changes in either firing rate or variability with time. 4. We conclude that single motoneurones supplying the extensor hallucis longus, a muscle comprised primarily of slow twitch muscle units, show little adaptation in firing with fatigue, suggesting that a progressive reduction in firing rate is not an invariable consequence of the fatigue associated with sustained maximal voluntary contractions.
Measurements of blood flow rate in the pulp of the thumb, the first toe, the ear lobe, and the nose were performed using the heat-washout method, and the 133Xe-washout method under orthostatic changes in humans. Blood flow rate measured by the heat-washout method in the thumb was about 127.5 ml (100 g x min)-1 at heart level in two subjects, (n=10), and in the pulp of the first toe in 6 subjects (n=12) 49.3 ml (100 g x min)-1 at heart level. Above heart level blood flow rate decreased with the falling pressure head, and 50 cm below heart level blood flow remained unchanged compared to heart level. The arterioles supplying the capillaries in this region showed autoregulation of blood flow to 50 cm above heart level, but a veno-arteriolar reflex was not present. Blood flow rate in the ear lobe and on the side of the nose showed a similar pattern of reaction, with a blood flow rate in the arteriovenous anastomoses of about 100 ml (100 g x min)-1 in sitting position.
BACKGROUND: The finger, toe, and nail unit are rare sites of basal cell carcinoma (BCC). Only a few patients with BCC of the foot have been described in the world literature, and ungual BCC is even less frequent. OBJECTIVE: To discuss through a case report the clinical features and diagnosis of BCC of the foot. METHODS: We report an unusual case of BCC of the nail unit of the fifth toe of an elderly woman that mimicked chronic dermatitis. CONCLUSION: Our case clearly highlights the need for biopsy and histopathologic examination whenever we see inflammatory lesions with a loss of substance that are refractory to systemic or topical treatments.
1. The discharge properties of individual motor units in different modes of voluntary contraction were studied with electromyographic techniques in the short toe extensor muscle of normal man. 2. The short toe extensor muscle consisted of type I and type II muscle fibres in about equal proportion. In some subjects there was type-grouping so that recordings with sufficient selectivity could easily be obtained. 3. Certain motor units could be driven continuously, attained regular firing intervals even at a firing rate of 10/sec, increased slowly in firing rate with increase in contraction strength, had maximum firing rate below 30/sec during sustained contraction but above 60/sec in twitch contraction. 4. Other motor units could not be dirven continuously, did not fire repeatedly at rates below 20/sec, increased rapidly in firing rate with increase in contraction strength and attained firing rates above 100/sec. 5. There were intermediate forms between continuously firing low frequency motor units and intermittently firing high frequency motor units. 6. In a prolonged contraction of constant strength only continuously firing motor units were active. 7. On rapid accelerations, however, both continuously and intermittently firing motor units were active and played about the same role. 8. This applied also to prolonged series of accelerations as in rhythmically alternating movements. 9. In twitch contractions selective activation of intermittently firing motor units occurred if the muscle was relaxed prior to the twitch and great effort was used to elicit the twitch and minimum duration of the twitch was intended. 10. It is suggested that continuously firing low frequency motor units have type I muscle fibres and intermittently firing high frequency units have type II muscle fibres and that the order of recruitment and the relative roles of the two motor unit types are adapted to the mode of contraction.
A new syndrome was recently reported with the descriptive title of "painful legs and moving toes". The present paper describes five patients who developed this syndrome following minor trauma to the legs, which in three patients was attributable to surgery. Various mechanisms that may underlie this unusual combination of severe leg pain with involuntary movements of the toes are discussed, as is the role of previous injury. The possibility is considered that whilst the condition may be generated peripherally, a persistent abnormality of the central nervous system consequently develops.