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PubMedDate not supplied

Toe-to-thumb transplantation.

Microsurgical techniques have become useful in reconstructive surgery of the hand. Toe-to-thumb transplantation currently is the procedure of choice for thumb loss reconstruction. For a successful outcome, meticulous planning is imperative and presumes a thorough knowledge of the pertinent anatomy and surgical technique. The method of thumb reconstruction must be individualized and is dependent on the patient's functional needs, age, and the level of thumb amputation. Postoperatively, diligent nursing care is essential in assuring a positive outcome. Continuous communication between physicians and nurses is crucial. Astute monitoring and assessment are the core components of successful care.

Amputation, Traumatic↗
PubMed1979

Free toe-to-fingertip neurovascular flaps.

Six cases of free toe-to-fingertip neurovascular flaps are presented. The principal advantages of this procedure over rotation island flaps are (1) achievement of better two-point discrimination, (2) an acceptable donor defect, (3) no cortical reorientation is necessary, and (4) there is minimal tension on the nerve.

Adolescent↗
PubMed1983

Syndactyly of the toes.

The experience gained through the management of 43 patients with syndactyly of the toes is presented. The incidence appears to be similar to that of syndactyly of the fingers. Type 1 syndactyly, or zygodactyly, always presented itself as a cosmetic problem; its correction is occasionally indicated and the procedure used is discussed. Type 2 syndactyly, or polysyndactyly, represents a functional problem and deserves surgical correction. My negative experience with the more complex procedures described for the correction of polysyndactyly is presented as well as my satisfaction with the simpler procedures. Suggestions for management are offered.

Esthetics↗
PubMed1985

Functional reconstruction of both hands by free transfer of combined second and third toes from both feet.

The correction of severe trauma to both hands by two major microsurgical operations and additional minor interventions on the already functioning transplants is described. The excision of combined second and third toes as transplants inflicts an injury on the foot, but for our patient this iatrogenic trauma was justified. Careful investigation of the feet after transfer shows that their condition does not significantly impair the quality of the patient's life. The special importance of the patient's desire to regain his or her abilities and to collaborate with the medical staff is emphasized.

Amputation, Surgical↗
PubMed1990

Small toe muscles for defect coverage.

Defects on the sole of the foot are always a major problem. Frequently, these patients suffer from other diseases, such as diabetes mellitus, chronic vascular diseases, or skeletal deformities. Usually, these are full-thickness defects and the bone is exposed. Beside other possibilities, the short muscles of the fifth toe provide a viable muscle flap for coverage of small defects, especially on the lateral side of the foot.

Adolescent↗
PubMed1991

Custom-made free vascularized compound toe transfer for traumatic dorsal loss of the thumb.

Dorsal compound traumatic thumb loss can be reconstructed in selected young and well-motivated patients with a custom-made partial great toe transfer. The transfer, including the nail complex and vascularized piece of bone, can be fashioned by longitudinally cutting the distal phalanx to approach the appearance of the opposite thumb and to allow for more normal nail appearance. Ten patients illustrate this technique and emphasize its reconstructive potential as well as cosmetic acceptance.

Adolescent↗
PubMed1991

Second toe wrap-around flap.

The microsurgical second toe wrap-around technique is an ideal treatment option for reconstruction of the distal half of the finger with circumferential loss of skin and nail associated with an uninjured proximal interphalangeal joint and an intact insertion of the flexor digitorum superficialis tendon. Follow-up of 13 flaps in 10 patients from 1986 to 1989 demonstrates rapid and adequate functional recovery as well as satisfactory aesthetic appearance in all patients.

Adolescent↗
PubMed1998

The bipolar lengthening technique: a modified partial toe transfer for thumb reconstruction.

The authors describe a new technique for reconstruction of the thumb after amputation through the proximal phalanx. Bipolar lengthening is a combination of first web deepening by an Ostrowski flap and a distal lengthening by a free vascularized compound transfer of pulp, nail, and bone harvested longitudinally from the distal phalanx of the great toe. Seven cases have been reviewed by an independent observer after a mean follow-up of 46 months. There were no technical failures. The mean static 2-point discrimination was 6.3 mm, and the Semmes-Weinstein monofilament testing was identical to that of the contralateral side in four patients and increased in the other three. After correction for hand dominance, grip strength was 89 percent of that of the contralateral side, and pinch strength was 81 percent of that of the contralateral side. First web span was symmetric in four patients and diminished in the other three. The bipolar technique creates a short thumb, which avoids exposing the thumb to trauma when making a fist, without limiting first web span.

Adolescent↗
PubMed1998

Tissue preservation in hand injury: the first step to toe-to-hand transplantation.

The recommendations outlined in this editorial for the initial management of nonreplantable amputation injuries emphasize tissue preservation. This facilitates future toe-to-hand transplantation in terms of reconstructive options, functional and aesthetic outcomes in the hand, and donor-site morbidity in the foot. It is hoped that surgeons involved in the emergency surgical care of such cases will find these guidelines useful. Although tissue conservation is the main goal at this stage of treatment, this should not be at the expense of tissue viability. If in doubt about management issues, advice should be sought from the reconstructive microsurgery unit.

Finger Injuries↗
PubMed2005

Late inguinal metastasis of a well-differentiated subungual squamous cell carcinoma after radical toe amputation.

BACKGROUND: Although squamous cell carcinoma (SCC) is commonly found on sun-exposed skin, this malignancy in nail beds is rare. There is a very low rate of metastases, especially for well-differentiated lesions without bony involvement. OBJECTIVE: To present a case of late inguinal metastasis after radical toe amputation 3 years previously for subungual SCC. MATERIALS AND METHODS: Case report. RESULTS: The patient received modified inguinal lymphadenectomy and adjuvant radiation therapy. No recurrence or metastases were observed for 12 months. CONCLUSION: For patients with subungual SCC postsurgery, it is important to regularly evaluate for a minimum of 3 years, despite the very low rate of metastases.

Amputation, Surgical↗
PubMed2005

Hair-tourniquet syndrome--multiple toes and bilaterality.

The hair-tourniquet syndrome involves circumferential strangulation of an appendage by a human hair or fibre and usually affects infants under the age of 2. It is an emergency condition that induces progressive oedema, ischaemia and tissue necrosis and can lead to the autoamputation of digits or other strangulated structures. Though the majority of cases are accidental, a proportion may be due to nonaccidental injury. The prompt diagnosis and treatment of the condition is vital to attain a good outcome and prevent further harm to the child. We report a case of hair-tourniquet syndrome affecting multiple toes of an infant, and suggest that awareness of the condition should be increased to help prevent its potential complications.

Female↗
PubMedDate not supplied

Outcome of patients after Achilles tendon lengthening for treatment of idiopathic toe walking.

Fifteen children who were diagnosed with idiopathic toe walking that cannot be corrected by nonoperative treatment were assessed by clinical examination and computer-based gait analysis preoperatively and approximately 1 year after Achilles tendon lengthening. Passive dorsiflexion improved from a mean plantarflexion contracture of 8 degrees to dorsiflexion of 12 degrees after surgery. Ankle kinematics normalized, with mean ankle dorsiflexion in stance improving from -8 to 12 degrees and maximum swing phase dorsiflexion improving from -20 to 2 degrees. Peak ankle power generation increased from 2.05 to 2.37 W/kg but did not reach values of population norms. No patient demonstrated clinically relevant triceps surae weakness or a calcaneal gait pattern. Seven patients had a stance phase knee hyperextension preoperatively, and 6 of these corrected after surgery. Achilles tendon lengthening improves ankle kinematics without compromising triceps surae strength; however, plantarflexion power does not reach normal levels at 1 year after surgery.

Achilles Tendon↗
PubMed2006

Recovery of disused replanted digits by second toe hemipulp flap transfer.

BACKGROUND: Amputation of the distal phalanx is the most common among all mutilation injuries. Generally, it has been believed that the prognosis of this type of amputation is satisfactory; however, disuse of digits because of severe atrophy and sensory disturbances is frequently observed in the follow-up period. METHODS: The authors intended to use the second toe hemipulp flap for recovery of these disused digits and transferred the flaps to eight severely atrophic postreplanted digits. Objective sensory recovery was assessed along with estimation of the "usefulness" of the reconstructed fingers. RESULTS: No complications were observed postoperatively, and estimations of the functional results were almost satisfactory. CONCLUSION: This procedure significantly improved the prognosis of the replantation of severely crushed digits.

Adolescent↗
PubMed2005

Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers.

Microsurgical operations of the hand are common procedures of reconstructive surgeons. Sympathetic blockade of the vessels provides increased blood flow to the injured extremity, which increases the success rate of the surgery. Moreover, postoperative pain management can be performed with continuous blockade of the nerves. In this article, the effect of continuous brachial plexus blockade on patients who underwent upper extremity microsurgical operation was evaluated.A total of 16 patients were operated on either for replantation or for toe-to-hand transfer. The first group (n = 9) received combined continuous brachial plexus blockade and general anesthesia, and postoperative pain management was performed with continuous brachial plexus blockade. The remaining 7 patients operated on general anesthesia and conventional pain management. All transplant and replants were followed by use of Doppler flowmeter. Pain was scored by visual analog scale every 4 hours postoperatively. Continuous brachial plexus blockade was found to be effective in both sympathetic blockade and postoperative pain management. Continuous brachial plexus blockade must be considered when microvascular anastomosis is performed at the upper extremity, especially at the digital vessels, which are very susceptible to vasospasm.

Adolescent↗
PubMed2006

Rational treatment for multiple digit congenital absence: case report of nonvascularized toe phalangeal transfers and distraction lengthening for symbrachydactyly.

A case is discussed in which a young male was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits when he was an infant. This initial surgical procedure was later followed by webspace deepening and ultimately by distraction lengthening of the digits. At 8 years of age, he has a very functional hand with mobile metacarpophalangeal joints in all reconstructed fingers. In fact, he uses this reconstructed right hand as his dominant extremity. The case is discussed in context of phalangeal growth potential, specific indications for this type of reconstruction, and final long-term outcome. This case also helps to recommend rational treatment protocols for similar congenital hand anomalies.

Bone Transplantation↗