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At least 1,135 records · Page 63Linked to original sources
PubMed1996

Thenar flap rehabilitated: a review of 20 cases.

The thenar flap is a satisfactory reconstruction technique for the treatment of extensive loss of the distal phalanx of the index and middle fingers. As we observed in this series of 20 patients, this flap is reliable and provides tissue that closely matches the missing finger pulp. Flap sensibility is good (average Weber of 6.5 mm). Transferring a distally based flap prevents proximal interphalangeal joint contracture and allows the surgeon to better reconstruct the outlines of the distal phalanx, thereby reducing the risk of a clawed nail. Finally, we did not observe major postoperative complications at the donor site.

Adolescent↗
PubMed1997

Homodigital neurovascular island flaps with "direct flow" vascularization.

Pulp loss of the fingers is frequently observed. When local advancement flaps are not sufficient to repair the defect, the homodigital monopedicled island flaps with "direct flow" are a simple and current reconstructive solution. Between 1991 and 1995, 32 homodigital neurovascular direct flow island flaps were performed for fingertip defects. We used a modified triangular Venkataswami flap for oblique amputations (26 patients) and the Mouchet-Gilbert island flap for tangential defects (6 patients). Our results (with excellent skin quality and good sensory recovery) lead us to consider these flaps as the first-choice reconstructive solution in patients with extensive but not complete pulp defects (< 2 cm) of the fingers.

Adult↗
PubMed1997

Salvage of fingertip amputated at nail level: new surgical principles and treatments.

In this study, a new classification of fingertip amputation based on the surgical treatment is reported. Specifically, the necessity for special procedures to prevent venous congestion in fingertip replantation at the nail bed level was studied. There are some reports of successful replantations without venous anastomoses. In order to avoid technical factors, clinical cases operated on by a single surgeon were evaluated to determine what treatment is necessary for amputations at various levels to avoid necrosis due to venous congestion. During the 5-year period from October 1987 to October 1992, 150 replantations in 137 patients were performed, including 49 fingertip replantations in 45 patients who were operated on consecutively by a single surgeon. The distal phalanx (DP) of the finger was classified as zone DP-I, IIA, IIB, and III from distal to proximal. This classification was based not only on the amputation level but also on the difference in surgical treatment. For amputations of zone DP-I, which extends from the fingertip to the most distal dividing point of the digital artery, the amputated fingertip is attached without vascular anastomosis and the whole finger is wrapped in aluminium foil and cooled in ice water for 3 days. For amputations of zone DP-IIA and IIB, anastomosis of the digital artery is performed in the central portion of the palmar region of the finger, but Kirschner wire fixation is not performed so as not to disturb the venous drainage through the medullary cavity. For amputations of zone DP-IIA, special treatment is not necessary for venous congestion, and for those of zone DP-IIB partial resection of the nail is done if necessary. For zone DP-II amputations, venous anastomosis must be performed for salvage. All patients were operated on according to the procedures based on this classification and final survival rate was 91.5%.

Adult↗
PubMed1998

The dorsal metacarpal flap for secondary digital artery flap donor sites.

The effective approach of the reverse digital artery flap for reconstruction of the distal phalanges, fingertips, and finger pulp is used widely in a clinical setting. However, the most potential problem is that digital artery flap donor sites cannot be closed primarily. We have used distally based dorsal metacarpal flaps to cover secondary digital artery flap donor sites in 12 patients. The use of adjacent tissue provided the best possible texture and color match for the dorsal half of the lateral side of the finger. This allowed aesthetically superior wound closure to that achieved by conventional methods employing skin grafts.

Adolescent↗
PubMed2000

The effects of the number and ratio of repaired arteries and veins on the survival rate in digital replantation.

From January 1990 to December 1998, 631 consecutive single-digit replantations were reviewed retrospectively to determine the essential number of vascular anastomoses and the artery-to-vein ratio for successful finger replantation. The correlations between the number and the ratio of anastomosed vessels and the survival rate were examined according to the amputated digital levels, and all of the correlated results were compared with each other statistically. In zone I, the survival rate of the digits with a vein repaired was higher than that of digits treated with the external bleeding method. In zone II, repairing more arteries than veins led to venous congestion and resulted in a failure of replantation. Thus, the ratio of an equal or greater number of veins repaired to the arteries repaired was an important factor in successful replantation in zone II, which may be due to the large amount of arterial input relative to the small volume of venous drainage via small veins in the replanted digit. In zone III, the equal number of arteries and veins repaired was also an important factor in successful replantation. However, unlike zone II, even when more arteries were repaired than veins, venous congestion occurred rarely because the vein in this area was larger, providing sufficient venous drainage. In zone IV, repair of two veins was needed to yield good results. Because the volume of the amputated part in zone IV was larger than in other zones, it was desirable to repair both arteries, even though repairing one artery yielded good results. In conclusion, it is desirable to repair as many vessels as possible to increase the possibility of a good result. However, digital amputations and their conditions for replantation differ. Therefore, the number and ratio of vessels that need to be repaired should be modified and adjusted in each case.

Amputation, Traumatic↗
PubMed2000

A modified reversed digital island flap incorporating the proper digital nerve.

A standard reversed digital artery flap is based on the digital artery and vena comitantes alone, leaving the proper digital nerve intact. In the authors' opinion, in situations in which the fingertip pulp is lost completely, it is unnecessary to leave the nerve in situ. Using their technique, the proper digital nerve is included in the pedicle. The pedicle is raised as a monobloc of fatty tissue containing the small veins important for drainage. The proper digital nerve in the flap is sutured to the stump of the opposite proper digital nerve. They found this flap to be very reliable, and quite easy and quick to raise. A patient is presented and discussed in detail.

Adult↗
PubMed2001

Fingertip replantation at or distal to the nail base: use of the technique of artery-only anastomosis.

The authors describe the functional and aesthetic results of microsurgical replantation of 21 fingertip amputations at or distal to the nail base-namely, zone I amputations. There were 15 male and 6 female patients, with an average age of 26 years (age range, 1-41 years). Replantations were performed using the anastomosis of the artery-only technique, with neither vein nor nerve repair. Venous drainage was provided by an external bleeding method with a fish-mouth incision in "distal" zone I amputations for approximately 7 days, and by the use of leeches in more "proximal" zone I amputations for 10 to 12 days. Results indicated that the overall survival rate was 76%, with 16 of 21 digits surviving. Sensory evaluation at an average follow-up of 12 months (range, 6-18 months) revealed an average static two-point discrimination of 6.1 mm (range, 2.0-8.0 mm). Considering the unfavorable results and the donor site morbidity of various fingertip reconstructions, a microsurgical fingertip replantation should always be considered except in extremely distal, clean-cut, pediatric cases, in which case a composite graft is a possibility. The results of this series indicate that an amputated fingertip in zone I can be salvaged successfully by microvascular anastomosis of the artery only, with a nonmicrosurgical method of venous drainage. Furthermore, acceptable sensory recovery can be expected without any nerve coaptation.

Adolescent↗
PubMed2001

Microvascular free on-top plasty in a mutilated hand.

Amputation of the index, middle, and ring fingers leaves a poor, unstable pinch and grasp between the thumb and little finger. In this type of mutilated hand, it is necessary to reconstruct one or two fingers for firm chuck pinch and good grasp. Functionally and cosmetically, toe transfer is superior to other methods of finger reconstruction because of its mobility, sensibility, pulp size, and nail availability. However, a transfer from the foot may not always be available. In such a case, any finger stump may be considered as a possible donor finger. The authors performed a microvascular free transfer of the remaining portion of the ring finger including the metacarpophalangeal joint to the top of the remaining portion of the index finger in a mutilated hand with intact thumb and little finger because the patient declined toe transfer. Postoperatively, more effective strength and stability, provided by three converging digits, was achieved in the hand. Accordingly, it was easier for the patient to grip small and large objects. The authors describe this procedure as a microvascular free on-top plasty.

Adult↗
PubMed2001

Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery.

A new homodigital neurovascular island flap for fingertip reconstruction, called a volar digital island flap, is described. The flap is perfused from the proper digital artery through the transverse palmar branch, and is drained through the tiny venules and capillaries contained in the perivascular soft tissue. Between 1997 and 2000, 25 fingers from 23 patients with defects of the middle and distal phalangeal areas were reconstructed using this flap. All flaps survived well. Patient age ranged from 17 to 65 years (average age, 32.5 years). Long-term follow-up for more than 6 months was possible in 15 fingers from 14 patients. Light touch and temperature sensation could be detected in all the flaps evaluated. The mean value of the static two-point discrimination test was 4.2 mm. Although this flap requires the sacrifice of important volar skin, it provides excellent padding and sensation for fingertip reconstruction. The authors think that this new flap is an alternative choice for coverage of fingertip defects.

Adult↗
PubMed2002

Bilateral side finger transposition flaps in the treatment of chronic postburn flexion contractures of the fingers.

The authors present a surgical method of releasing postburn flexion contracture of the finger by two separate transverse incisions and covering the skin defects by transposing two random-pattern flaps from both sides of the finger. One of the proximally based flaps was transposed from one side of the proximal phalanx and the other flap was transposed from the opposite side of the middle phalanx. Because the flaps were raised from different sides of different phalanxes, the donor sites were closed primarily. A total of 37 fingers (14 hands, 11 patients) were treated with this method. The patients were all men aged 20 to 24 years old. The mean follow-up period was 9 months. The lack of extension of the proximal interphalangeal joints of the fingers was improved by approximately 45 deg using the described method. The authors conclude that this method can be used effectively in the treatment of mild to moderate postburn flexion contractures of the fingers.

Adult↗
PubMed2002

Modification of the extension block Kirschner wire technique for mallet fractures.

A modification of the extension block Kirschner wire technique that is used for closed reduction of mallet fractures is described. Eighteen mallet avulsion fractures of the distal phalanx treated with this modification were included in this prospective study. The fingers affected were nine small fingers, eight ring fingers, and one long finger. Surgical indications included fractures involving more than 33% of the articular surface and fractures associated with subluxation of the distal phalanx that could not be corrected by closed reduction. The average joint surface involvement was 39.8%. At followup, only one patient had pain, and that was graded as minimal. Objectively, congruous and satisfactory joint surfaces were present in 17 patients. No patient had pseudarthrosis. The average active flexion of the distal interphalangeal joint was 81.1 degrees and the average extensor lag was 1.6 degrees. Neither pin tract infections nor migration of the pins occurred. The average followup was 27.3 months. This modification increased range of motion at the distal interphalangeal joint and showed a trend toward reduced permanent extensor lag when compared with the original method. This technique should be considered when treatment of the mallet fracture is being planned using the extension block Kirschner wire technique.

Adult↗
PubMedDate not supplied

Monoarticular gout following trauma: MR appearance.

We report a case of gout with monoarticular tophaceous involvement of the proximal interphalangeal joint of the middle finger, emphasizing MR findings. To the best of our knowledge, the MR appearance of gout is not commonly known.

Arthritis, Gouty↗
PubMed1994

Proximal interphalangeal joint autofusions after extensive burns.

Seven patients with third-degree burns of > 70% of their body had autofusions of 19 proximal interphalangeal joints. In 13 of the joints there was fixed deformity of > 60 degrees. In addition to these deformities, each of the patients had deformities due to burns in the axilla and elbows bilaterally. There was only one independently functional hand and in that hand no proximal interphalangeal joint deformity was > 40 degrees. Two patients were totally dependent because of either bilateral involvement or infectious complications of the burn itself. In four patients the hand was used as a helping hand to some extent. In each of these four the patient had a less involved other hand and had satisfactory activity of daily living skills as a consequence. Early splinting or skeletal fixation of burned joints developing flexion positions might have avoided autofusions in poor position.

Activities of Daily Living↗