Gait Analysis of the Donor Foot in Microsurgical Reconstruction of the Thumb

1995 ◽  
Vol 16 (4) ◽  
pp. 201-206 ◽  
Author(s):  
Francesco Barca ◽  
Alessandro Santi ◽  
Pier Luigi Tartoni ◽  
Antonio Landi
Keyword(s):  
Donor Site ◽  
Hallux Rigidus ◽  
Metatarsal Bone ◽  
Wilcoxon Test ◽  
Great Toe ◽  
Microsurgical Reconstruction ◽  
The Third ◽  
Metatarsal Bones ◽  
Toe Transfer ◽  
Second Toe

Clinical and step evaluations by a piezoelectric system board were performed in 54 patients who underwent microsurgical reconstruction of the thumb by great or second toe transfer. Forty-four patients were male and 10 were female. In 13 cases, the thumb was reconstructed by the Morrison wrap-around technique. In 27 cases, an extended variant of the Morrison technique was used in which the whole distal phalanx was harvested with skin and nail apparatus. Four patients were treated by great toe transfer and 10 were treated by second toe transfer. Follow-up ranged from 2 to 144 months. The group of patients treated by the wrap-around technique presented hallux rigidus in 38.5% of cases. The group of patients treated by the extended variant of the Morrison technique presented a lesser tendency to hallux rigidus but a clear reduction of the pushing phase of hallux. The group of patients treated by second toe transfer presented a third and fourth metatarsal bone overload that was confirmed by a statistical Wilcoxon test: overload was linked to a plantar hyperkeratosis at the third metatarsal (20%), fourth metatarsal (10%), or fifth metatarsal bone (20%). A claw deformity of the third and fourth toes was observed in 20% of these patients. The four patients who underwent microsurgical reconstruction of the thumb by great toe transfer exhibited an overload of central and lateral metatarsal bones. Second toe transfer is not associated with the functional or cosmetic changes seen in great toe transfer and is therefore preferred. The cosmetic and functional results from extended great toe transfer make this a much less desirable transfer than the wrap-around or modified wrap-around technique. The transfer with the least donor site problem is second toe to thumb.

Functional Evaluation of a Great Toe Transfer and the Osteoplastic Technique for Thumb Reconstruction in the Same Individual

2003 ◽  
Vol 28 (5) ◽  
pp. 405-408 ◽  
Author(s):  
S. R. SABAPATHY ◽  
H. VENKATRAMANI ◽  
R. R. BHARATHI
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Functional Evaluation ◽  
Great Toe ◽  
Thumb Reconstruction ◽  
Microsurgical Reconstruction ◽  
Functional Activities ◽  
Reconstructive Option ◽  
Toe Transfer

Since the popularization of microvascular toe transfer, there has been a tendency to relegate osteoplastic reconstruction techniques for the thumb to history. A case is presented which shows that a successful and well-planned osteoplastic thumb reconstruction can match microsurgical reconstruction in all functional activities. Cosmetically, the toe transfer is the better reconstructive option but it may cause significant donor site morbidity.

scholarly journals The Utility of the Knotless Suture Fixation for Bilateral Second Toe Transplantation in Traumatic Multiple-Digit Amputation

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Yasuhiro Yamamoto ◽  
Satoshi Ichihara ◽  
Akira Hara ◽  
Toshiya Kudo ◽  
Yuichiro Maruyama ◽  
...  
Keyword(s):  
Donor Site ◽  
Limited Range ◽  
Reconstruction Method ◽  
Suture Fixation ◽  
Limited Range Of Motion ◽  
Good Cosmetic ◽  
Cosmetic Outcomes ◽  
Toe Transfer ◽  
Second Toe ◽  
Fixation System

Toe-to-hand transfer is a useful reconstruction method after finger amputation. We report a case of multiple-digit amputation, reconstructed with bilateral second-toe transfer. In this study, we used a knotless suture fixation system (ZipTight™; Arthrex Inc., FL, USA) which effectively closed the wound and reduce the amount of dead space. Both second-toe transplantations survived. The feet were asymptomatic with good cosmetic outcomes. Although the reconstructed digits had limited range of motion, the patient was able to return to work. Knotless suture fixation system may be one of the effective methods for closing the donor site wound in second-toe transplantations.

scholarly journals Cosmetic and Functional Results of a Newly Reconstructed Thumb by Combining the Phalange of Second Toe and the Great Toenail Flap Transplantation

2020 ◽  
Author(s):  
Yefeng Yin ◽  
Xiaomei Tao ◽  
Yanzhao Li ◽  
Buhe Bao ◽  
Ying Ying ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Great Toe ◽  
Thumb Reconstruction ◽  
Aesthetic Result ◽  
Aesthetic Results ◽  
Distal Interphalangeal ◽  
The Common ◽  
Toe Transfer ◽  
Second Toe

Abstract BACKGROUND Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor aesthetics. Great toe transplantation achieves better aesthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and aesthetic satisfaction in thumb reconstruction.METHODS We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalange transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). RESULTS 1 patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and aesthetic results of both the donor and the recipient sites were satisfactory.CONCLUSIONS Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and 2nd toe phalange achieved a substantially better functional and aesthetic result in the thumb reconstruction.

Paediatric toe-to-hand transfer: an assessment of outcomes from a single unit

2015 ◽  
Vol 41 (3) ◽  
pp. 281-294 ◽  
Author(s):  
D. Nikkhah ◽  
N. Martin ◽  
M. Pickford
Keyword(s):  
Range Of Motion ◽  
Hand Function ◽  
Donor Site ◽  
Level Of Evidence ◽  
Reliable Technique ◽  
Special Review ◽  
Active Range Of Motion ◽  
The Mean ◽  
Toe Transfer ◽  
Second Toe

Toe-to-hand transfer is an acceptable treatment option for children born with absent digits. Toe transfer can provide functionally useful digits and may enhance patient wellbeing. A total of 19 children had 31 free second-toe-to-hand microsurgical transfers between 1998 and 2012. The mean age of these children at the time of the first operation was 45 months. All transferred toes survived. The donor site was satisfactory in all 19 patients. Twelve children (19 toes) attended a special review clinic; all children could grasp large objects (Duplo bricks) after toe transfer. The total passive range of motion was greater than total active range of motion by an average of 54 degrees. Static 2-point discrimination was generally excellent (mean = 5 mm). Eleven out of 12 children strongly agreed that their toe transfer had improved hand function. Microsurgical toe-to-hand transfer is a safe and reliable technique that can provide useful function for children with congenital differences. Our series compares favourably with the published literature. Level of evidence: IV

scholarly journals Radiographic features of the dorsal condylar sagittal ridge of the third metacarpal and metatarsal bones in young Warmblood stallions

2010 ◽  
Vol 23 (06) ◽  
pp. 411-416 ◽  
Author(s):  
A. Martens ◽  
J. Declercq ◽  
V. Busoni ◽  
K. Vanderperren ◽  
H. van Bree ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Metatarsal Bone ◽  
Research Fund ◽  
Bone Surface ◽  
Radiographic Appearance ◽  
The Third ◽  
Dorsal Aspect ◽  
Metatarsal Bones ◽  
The Individual ◽  
Metatarsophalangeal Joints

Summary Objectives: To describe the radiographic appearance of the dorsoproximal aspect of the sagittal ridge of the third metacarpal/metatarsal bone in Warmblood horses. Methods: The lateromedial radiographic projections of the metacarpo-/metatarsophalangeal joints performed on horses as a part of stallion selection were used. The dorsal aspect of the distal third metacarpal/metatarsal bone was divided in two areas. The appearance of the bone surface in area I was classified as normal, irregular, notch, indentation and lucency. For area II, the categories were normal, irregular, depression or lucency and flattening of the sagittal ridge. Other abnormalities at the dorsal aspect were also noted. Results: In area I, 51.5% of the ridges appeared normal, 19.3% were irregular, 8.9% had a notch, 8.1% had a lucency, and 12.2% had an indentation. In 1.2% of the horses a fragment was present, and in 1.7% a fragment was suspected.In area II, 90.6% of the metacarpo-/metatarsophalangeal joints were normal, 6.2% were irregular, 2.9% showed a depression or lucency, and the sagittal ridge in 0.2% was flattened. A fragment was present in 0.3%, and suspected in 0.4%. Clinical significance: Morphological variation is present at the dorsal aspect of the metacarpo-/metatarsophalangeal joint in young Warmblood stallions. These various aspects should be recognised and described in horses presented for prepurchase examination. However, their clinical relevance in the individual horse is unclear and needs further investigation.Funding: Stijn Hauspie is a research fellow of the “Special Research Fund”, Ghent University (Belgium).

scholarly journals Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yefeng Yin ◽  
Xiaomei Tao ◽  
Yanzhao Li ◽  
Buhe Bao ◽  
Ying Ying ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Great Toe ◽  
Distal Interphalangeal Joint ◽  
Thumb Reconstruction ◽  
Distal Interphalangeal ◽  
The Common ◽  
Toe Transfer ◽  
Second Toe ◽  
Different Levels

Abstract Background Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe, and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor esthetics. Great toe transplantation achieves better esthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and esthetic satisfaction in thumb reconstruction. Methods We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalanx transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). Results One patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and esthetic results of both the donor and the recipient sites were satisfactory. Results show that, for patients with traumatic thumb defects, the combined transfer of flap and second toe phalanx was the best option. Conclusions Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and second toe phalanx achieved a substantially better functional and esthetic result in the thumb reconstruction.

scholarly journals Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

2020 ◽  
Author(s):  
Yefeng Yin ◽  
Xiaomei Tao ◽  
Yanzhao Li ◽  
Buhe Bao ◽  
Ying Ying ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Great Toe ◽  
Thumb Reconstruction ◽  
Aesthetic Result ◽  
Aesthetic Results ◽  
Distal Interphalangeal ◽  
The Common ◽  
Toe Transfer ◽  
Second Toe

Abstract BACKGROUND Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor aesthetics. Great toe transplantation achieves better aesthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and aesthetic satisfaction in thumb reconstruction.METHODS We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalanx transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ).RESULTS 1 patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and aesthetic results of both the donor and the recipient sites were satisfactory. Results show that, for patients with traumatic thumb defects, the combined transfer of flap and 2nd toe phalanx was the best option.CONCLUSIONS Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and 2nd toe phalanx achieved a substantially better functional and aesthetic result in the thumb reconstruction.

Closure of the second toe transfer donor site without disruption of the deep transverse metatarsal ligament

Microsurgery ◽  
1994 ◽  
Vol 15 (11) ◽  
pp. 802-804 ◽  
Author(s):  
Howard R. Webster ◽  
Christopher J. Inglefield
Keyword(s):  
Donor Site ◽  
Toe Transfer ◽  
Second Toe

Culture Concordance in Different Sections of the Metatarsal Head: Interpretations of Microbiological Results

2021 ◽  
pp. 153473462110037
Author(s):  
Raul Juan Molines-Barroso ◽  
Esther García-Morales ◽  
David Sevillano-Fernández ◽  
Yolanda García-Álvarez ◽  
Francisco J. Álvaro-Afonso ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Bacterial Load ◽  
False Negative ◽  
Metatarsal Bone ◽  
High Rate ◽  
Microbiological Analysis ◽  
High Tendency ◽  
Metatarsal Bones ◽  
Bone Biopsies

Microbiological cultures of per-wound bone biopsies have shown a lack of correlation and a high rate of false-negative results when compared with bone biopsy cultures in diabetic foot osteomyelitis. The selection of samples from the area of active osteomyelitis, which contains a complete census of the microorganisms responsible for the infection, is essential to properly guide antimicrobial treatment. We aimed to comparatively evaluate the quantitative and qualitative cultures taken from different areas, in metatarsal heads resected for osteomyelitis. For this purpose, we consecutively selected 13 metatarsal heads from 12 outpatients with plantar ulcers admitted to our diabetic foot unit. Metatarsal heads were divided transversally into 3 portions: plantar (A), central (B), and dorsal (C), and the 39 resulting samples were cultured. Qualitative and quantitative microbiological analysis was performed, and the isolated species and bacterial load, total and species specific, were compared between the 3 metatarsal bone segments. The primary outcome of the study was the bacterial diversity detected in the different bone sections. Cultures were positive in 12 of the 13 included metatarsal heads (92%). A total of 34 organisms were isolated from all specimens. Ten of the 12 cultures (83%) were polymicrobial. Ten of the 13 metatarsal heads (77%) had identical microbiological results in each of the 3 bone sections. The largest number of microorganisms was found in the central section. The overall concordance between sections was 91%. The predominant microorganisms were coagulase-negative staphylococci (41%). Statistical differences were not found in the bioburden between sections (range 3.25-3.41 log10 colony-forming unit/g for all sections; P = .511). The results of our study suggest that microorganisms exhibit a high tendency to spread along the metatarsal bone and that the degree of progression along the bone is species dependent. The central portions of metatarsal bones tend to accumulate a higher diversity of species. Thus, we recommend this area of bone for targeted biopsy in patients with suspected osteomyelitis.

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