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Single dislocation of a joint in a finger is common, but simultaneous dislocation of both joints is a rare occurrence. Two further cases are reported with review of the literature.
A dislocation of the interphalangeal joint of a thumb was treated without problems. The simultaneous dislocation of the lunate was not diagnosed or treated until the plaster cast was removed. Even in cases with an obvious lesion like a finger joint dislocation it is necessary to investigate all other fingers and the wrist to exclude other lesions and to avoid delay in treatment.
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A controlled study of digital escharotomy showed a statistically significant increase in the number of salvaged phalanges. This procedure has minimal risk and should be considered in patients with vascular compromise of the upper extremity requiring escharotomy, who also have circumferentially burned fingers.
In dealing with skin losses of the proximal segments of the finger, one must be mindful of the vessel arrangements. Preservation of the axial vessels removes the usual restrictions of length to breadth ratios which apply to flaps planned on a random pattern arrangement.
Some possible reasons for the reported failures of digital neurovascular island flaps to provide normal (or near normal) tactile sensibility are discussed. Some technical variations which may improve the results are proposed. An illustrative case is reported in which there was transfer of intact two-point discrimination.
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Significant and lasting improvement in stiff MP and PIP joints can be achieved by operative management. Operative intervention should be considered only after persistence of stiffness after a vigorous program of nonoperative therapy. In our series of 135 such stiff finger joints, capsulotomy increased the range of motion in MP joints by more than 30 degrees in 68 percent of the patients, more than 50 degrees in 57 percent, and more than 70 degrees in 32 percent. The increased range of motion for the PIP joints was more than 30 degrees in 63 percent of the patients, more than 50 degrees in 41 percent, and more than 70 degrees in 25 percent.
We present a series of 8 children, all less than 6 years of age, which demonstrates the feasibility of primary microvascular replantation or reconstruction of amputated or devascularized parts in children. The function and the appearance obtained were excellent, and the potential for growth was maintained. Fortunately, the vessels were larger in these young children than one would expect. It is apparent that in a healthy, stable child, the careful application of microsurgical principles is an excellent method for salvaging devascularized or amputated parts that are vital for function or appearance.
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.
Toe-to-hand transfer was performed in 28 patients, involving 33 fingers, using microvascular technique. Of this number, 26 patients (31 fingers) had experienced trauma, and the remaining 2 patients (2 fingers) had a congenital deformity. The toew used for grafting were the great toe (1), the second tow (30), and third toe (2). Success was achieved in all cases, sensory recovery was good, and remarkable improvement was attained in function and cosmetic appearance. Metacarpal hand, amputation of thumb, and amputation thumb and three fingers were good indications for this procedure, which gave satisfactory aesthetic results, even in patients with amputation of single digits.