A BLAUTH IIIB HYPOPLASTIC THUMB RECONSTRUCTED WITH A VASCULARISED METATARSO-PHALANGEAL JOINT TRANSFER: A CASE REPORT WITH 28 YEARS OF FOLLOW UP

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 63-68 ◽  
Author(s):  
Hironori Matsuzaki ◽  
Satoshi Toishi ◽  
Takae Yoshizu
Keyword(s):  
Index Finger ◽  
Proximal Interphalangeal Joint ◽  
Extensor Indicis Proprius ◽  
First Choice ◽  
Abductor Digiti Minimi ◽  
Surgical Options ◽  
One Year ◽  
Foot Morbidity ◽  
Second Toe

We reconstructed the Blauth-IIIB hypoplastic right thumb of a 16-year-old girl with a vascularised metatarso-phalangeal (MTP) joint from her second toe combined with a dorsalis-pedis flap. Abduction was provided with an abductor policis long tendon advancement, and adduction, with an extensor indicis proprius tendon transfer. Opponoplasty was performed one year later using the flexor sublimis (IV) tendon. The transferred joint remained functional and non-osteoarthritic 28 years later. Radial and palmar abduction of the reconstructed thumb was 45° and 75° respectively. The index, middle, and ring fingers could oppose the thumb, however she grasped small objects between her index and middle fingertips. If a pollicisation using the index finger is not accepted, the reconstruction described here is one of the surgical options. However donor-foot morbidity is not negligible. Currently, we use a proximal-interphalangeal joint transfer with an opponoplasty using an abductor digiti minimi as a first choice, when planning a reconstruction of preserved hypoplasic thumb.

Immediate Free Vascularized Joint Transfer from Second Toe to Index Finger Proximal Interphalangeal Joint: A Case Report

1985 ◽  
Vol 10 (1) ◽  
pp. 85-89 ◽  
Author(s):  
T. M. TSAI ◽  
R. SINGER ◽  
E. ELLIOTT ◽  
H. KLEIN
Keyword(s):  
Index Finger ◽  
Extensor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Severe Injuries ◽  
Immediate Reconstruction ◽  
Joint Reconstruction ◽  
Results Of Treatment ◽  
Second Toe

The results of treatment of severe injuries to the proximal interphalangeal joint are unsatisfactory. The methods of joint reconstruction are discussed, including fusion, implant arthroplasty, perichondrial grafting and vascularized joint transfer. A patient is presented with a severe crush injury to the dorsum of the index finger with loss of skin and extensor tendon and proximal interphalangeal joint disruption. Immediate reconstruction of the finger is described using a composite free flap of skin, extensor tendon and proximal interphalangeal joint from the second toe. Follow-up at two years is described, demonstrating proximal interphalangeal motion and finger function.

Results of Vascularized Joint Transfers from the Foot

1997 ◽  
Vol 22 (4) ◽  
pp. 492-498 ◽  
Author(s):  
G. DAUTEL ◽  
M. MERLE
Keyword(s):  
Joint Space ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Indications For Surgery ◽  
Pip Joint ◽  
Prosthetic Implant ◽  
Metatarsophalangeal Joints ◽  
Second Toe ◽  
The Average Range

We report our results in ten cases of vascularized joint transfer to reconstruct the proximal interphalangeal joint (five cases) or metacarpophalangeal joints (five cases). Donor sites were the proximal interphalangeal or the metatarsophalangeal joints of the second toe. Indications for surgery were the need to reconstruct both the growth plate and joint space in children or the impossibility of a conventional prosthetic implant. The average range of motion was 44° for the PIP joint and 53° for the MP joint at a mean follow-up of 22.7 months.

Extensor Indicis Opposition Transfer in The Ulnar and Median Palsied Thumb in Leprosy

1996 ◽  
Vol 21 (5) ◽  
pp. 617-621 ◽  
Author(s):  
R. MEHTA ◽  
G. N. MALAVIYA ◽  
S. HUSAIN
Keyword(s):  
Index Finger ◽  
Donor Site ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexor Pollicis Longus ◽  
Extensor Pollicis Longus ◽  
Extensor Indicis Proprius ◽  
Leprosy Patients ◽  
Significant Deficit

Twenty seven opponensplasties for ulnar and median paralysis in 25 leprosy patients were performed using extensor indicis proprius. An additional transfer of the radial half of flexor pollicis longus to extensor pollicis longus was done to stabilize the metacarpophalangeal joint of the thumb. The biomechanical aspects of extensor indicis proprius tendon transfer were studied and results evaluated using various anatomical and functional parameters. Extensor indicis proprius provides adequate strength to position the thumb. However, sometimes it does not reach its new insertion. There is no significant deficit at the donor site but in a few cases the index finger may lose its capability for independent extension and sometimes a proximal interphalangeal joint contracture may develop.

scholarly journals Pediatric Glaucoma: A Literature’s Review and Analysis of Surgical Results

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Gianluca Scuderi ◽  
Daniela Iacovello ◽  
Federica Pranno ◽  
Pasquale Plateroti ◽  
Luca Scuderi
Keyword(s):  
Success Rates ◽  
Older Children ◽  
Advantages And Disadvantages ◽  
Pediatric Glaucoma ◽  
First Choice ◽  
Surgical Options ◽  
Aphakic Eyes ◽  
The Individual

The purpose of this paper is to review the surgical options available for the management of pediatric glaucoma, to evaluate their advantages and disadvantages together with their long-term efficacy, all with the intent to give guidelines to physicians on which elements are to be considered when taking a surgical decision. Currently there is a range of surgical procedures that are being used for the management of pediatric glaucoma. Within these, some are completely new approaches, while others are improvements of the more traditional procedures. Throughout this vast range of surgical options, angle surgery remains the first choice in mild cases and both goniotomy and trabeculotomy have good success rates. Trabeculectomy with or without mitomycin C (MMC) is preferred in refractory cases, in aphakic eyes, and in older children. GDIs have a good success rate in aphakic eyes. Nonpenetrating deep sclerectomy is still rarely used; nevertheless the results of ongoing studies are encouraging. The different clinical situations should always be weighed against the risks associated with the procedures for the individual patients. Glaucomatous progression can occur many years after its stabilization and at any time during the follow-up period; for this reason life-long assessment is necessary.

Effect of Volitional Inhibition on Cortical Inhibitory Mechanisms

2002 ◽  
Vol 88 (1) ◽  
pp. 333-338 ◽  
Author(s):  
Young H. Sohn ◽  
Katy Wiltz ◽  
Mark Hallett
Keyword(s):  
Index Finger ◽  
Motor Evoked Potentials ◽  
Intracortical Inhibition ◽  
Paired Pulse ◽  
Extensor Indicis Proprius ◽  
Inhibitory Mechanisms ◽  
Abductor Digiti Minimi ◽  
And Control ◽  
Conditioning Stimuli ◽  
Reaction Task

To investigate the effect of volitional inhibition on cortical inhibitory mechanisms, we performed transcranial magnetic stimulation (TMS) studies with a Go/NoGo reaction task in seven healthy subjects. Subjects were asked to extend their right index finger only after Go, but to remain relaxed after NoGo. Single- and paired-pulse TMS were triggered at the average reaction time for the Go response in each subject after Go or NoGo cues. Motor evoked potentials were recorded in the extensor indicis proprius (EIP) and abductor digiti minimi (ADM) muscles of right hand. Paired-pulse TMS with subthreshold conditioning stimuli at interstimulus intervals (ISIs) of 2 ms [short intracortical inhibition (SICI)] and 15 ms [intracortical facilitation (ICF)] and that with suprathreshold conditioning stimuli at ISI of 80 ms [long intracortical inhibition (LICI)] were performed in both Go/NoGo and control conditions. Inhibition of SICI was enhanced in both EIP and ADM after NoGo and was reduced only in EIP after Go. Inhibition of LICI was reduced in both muscles during both conditions, while ICF was not altered. The present results demonstrate that volitional inhibition enhances SICI but reduces LICI nonselectively. These results suggest that these two inhibitory mechanisms act differently during execution and suppression of voluntary movements.

scholarly journals Methods for Congenital Thumb Hypoplasia Reconstruction. A Review of the Outcomes for Ten Years of Surgical Treatment

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 610 ◽  
Author(s):  
Ozols ◽  
Butnere ◽  
Petersons
Keyword(s):  
Functional Results ◽  
Clinical Results ◽  
New Techniques ◽  
Extensor Indicis Proprius ◽  
Thumb Hypoplasia ◽  
Long Term Follow Up ◽  
Grade Ii ◽  
Second Toe

Background and objectives: Congenital thumb hypoplasia is a rare deformity of upper extremity. The incidence for thumb hypoplasia grade II–V is 1:10,000 newborns per year in Latvia. A technique for extensor indicis proprius (EIP) tendon transfer with subperiosteal fixation was developed and used for thumb hypoplasia grades II and IIIa. Pollicization or second-toe-to-hand transplantation with metatarsophalangeal (MTP) joint arthrodesis was used for the reconstruction of hypoplasia grade IIIb–V. The aim of this retrospective cohort study is to evaluate the outcomes for reconstruction techniques used in one surgical center during a ten-year period by one surgeon to evaluate functional and aesthetical outcomes for new techniques. Materials and Methods: In total, 21 patients were operated on during 2007–2017, and 18 of these patients were involved in this study. Long-term follow-up was completed to evaluate the functions and aesthetics of the hands. Results: disabilities of the arm, shoulder and hand (DASH) was 9.35 (8–10.7) for the second-toe-to-hand with MTP joint arthrodesis transplantation method for pollicization method 19.8 (6–26.7), and for the EIP tendon transposition, 14.54 (0.9–56.3). Conclusions: The postoperative functional parameters of congenital hand hypoplasia patients, regardless of the surgical method, are worse than the functional results of healthy patients. The use of the second-toe-to-hand with MTP joint arthrodesis transplantation method provides patients with congenital hand IIIb–V hypoplasia a stable and functional first finger formation. The functional results are comparable to the clinical results of the pollicization method while ensuring the creation of a five-digit hand.

scholarly journals Delayed presentation of extensor pollicis longus tendon injury treated using extensor indicis proprius tendon transfer

2019 ◽  
Vol 6 (11) ◽  
pp. 4138
Author(s):  
Nilesh B. Ghelani ◽  
Sankit Shah ◽  
Sunmathi B. P. ◽  
Samir Patel
Keyword(s):  
Tendon Transfer ◽  
Index Finger ◽  
Safe Procedure ◽  
Delayed Presentation ◽  
Extensor Pollicis Longus ◽  
Extensor Indicis Proprius ◽  
Closed Rupture ◽  
Flexion Extension ◽  
The Mean

Spontaneous closed rupture of EPL tendon are frequently associated with rheumatoid arthritis, Colles fracture, sports related injury. In cases of delayed presentation direct tendon repair is not feasible and a tendon transfer is usually recommended. In this study we evaluated the results of extensor indicis proprius (EIP) to extensor pollicis longus (EPL) transfers for EPL ruptures. Four patients, (two male and two females); mean age 32 years (range 20 to 45 years) with EPL tendon rupture underwent EIP to EPL tendon transfer. The mean duration from rupture to surgery was 4.5 weeks (range 4 to 6 weeks). Range of motion of the metacarpophalangeal (MCP), interphalangeal joints (IP) of the thumb and index finger of the operated side was compared with the normal side. The results were scored using geldmacher scheme, for the thumb four functions were scored, the radial abduction angle, the elevation deficit, the opposition distance and flexion extension deficit of MP and IP joints. The mean follow-up period was 5 months. All the four patients were able extend the thumb at MCP joint and oppose the thumb to the MCP of little finger after mean follow up of 5 months. Based on the questionnaire, the results of tendon transfer scored by three (75%) patients was excellent and by one (25%) patient was good. Independent extension of the index finger of operated hand was possible in all 4 patients. The procedure of EIP to EPL tendon transfer provides excellent result for extension of thumb. It is a safe procedure.

scholarly journals Conservative Approach in the Management of Large Periapical Cyst-Like Lesions. A Report of Two Cases

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 497
Author(s):  
Roxana M. Talpos-Niculescu ◽  
Malina Popa ◽  
Laura C. Rusu ◽  
Marius O. Pricop ◽  
Luminita M. Nica ◽  
...  
Keyword(s):  
Root Canal ◽  
Continuous Wave ◽  
Endodontic Treatment ◽  
Root Canal Filling ◽  
Surgical Interventions ◽  
First Case ◽  
First Choice ◽  
One Year ◽  
The One

Background and Objectives: Periapical cystic lesions are a pathology frequently addressed to endodontic specialists. Although their therapy is still not standardized, the treatment should be as conservative as possible and by endodontic means, as they are lesions of endodontic origin. The present case report describes two cases of upper central incisors with large cyst-like periapical lesions, and their one-year follow up. Materials and Methods: Endodontic orthograde treatment was performed under copious irrigation with sodium hypochlorite, in association with calcium hydroxide as an intra-canal medication for both teeth. Root canal filling was achieved in a separate appointment using the continuous wave of condensation technique. A decompression procedure was used in association with endodontic therapy in the second case to reduce the pressure inside the cystic lesion and to allow its drainage, and only because the root canal could not be dried three weeks after medication. Initial cone beam computed tomography (CBCT) investigations, as well as at the one-year follow up, were used to compare the evolution of the lesion. Results: Both cases had a favorable outcome. New bone formation in the periapical region and complete resolution of the lesion was observed at the one-year control in the first case. In the second case, although the lesion was still not completely healed at 12 months, a significant reduction in its size could be observed, showing active signs of healing. Conclusions: Endodontic treatment is the first choice option in the management of teeth with pulpal necrosis and large periapical cystic-like lesions. Decompression is the only surgical procedure recommended when the canals cannot be dried and obturated. Large surgical interventions are unnecessary in cases where endodontic treatment can be performed.

Restoration of Pinch in Ulnar Nerve Palsy by Transfer of Split Extensor Digiti Minimi and Extensor Indicis

1992 ◽  
Vol 17 (6) ◽  
pp. 622-624 ◽  
Author(s):  
D. ROBINSON ◽  
M. K. AGHASI ◽  
N. HALPERIN
Keyword(s):  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Index Finger ◽  
No Donor ◽  
Normal Side ◽  
Adductor Tubercle ◽  
Extensor Indicis Proprius ◽  
Ulnar Nerve Palsy ◽  
Post Traumatic

Subcutaneous transfer of the ulnar slip of the extensor digiti minimi (EDM) to the adductor tubercle across the dorsum of the hand restores pinch, and index finger abduction is reproduced by re-routing extensor indicis proprius around the thumb extensor tendons. Six patients with post-traumatic ulnar palsy have been treated by this method with a minimum follow-up period of 40 months. Pinch was improved from an average of 5% to 40–50% of the normal side, and index abduction to 30–40%. There was no donor morbidity.

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