scholarly journals Reconstruction of Traumatic Dorsal Loss of the Thumb: Four Different Surgical Approaches

Hand ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 223-229 ◽  
Author(s):  
Roberto Adani ◽  
Raffaele Mugnai ◽  
Giovanna Petrella
Keyword(s):  
Surgical Techniques ◽  
Medium Size ◽  
Dorsal Skin ◽  
Great Toe ◽  
Aesthetic Result ◽  
Custom Made ◽  
Kite Flap ◽  
Skin Loss ◽  
Radial Forearm ◽  
Toe Transfer

Background: This article outlines our methods for thumb reconstruction following dorsal skin loss injury located between the metacarpophalangeal joint (MPj) and the entire nail affecting skin, nail, tendon, and bone in different combinations but with intact sensate palmar skin. Methods: Between 1990 and 2015, 24 patients were treated for dorsal thumb defects using 4 different surgical techniques. Five cases of dorsal compound traumatic loss were reconstructed by custom-made dorsal great toe transfer. Four patients with dorsal skin and nail loss located at the distal phalanx level were covered with the homodigital flap with reverse flow vascularization. In 9 patients presenting skin defects between the MPj and the nail, reconstruction was achieved by means of the kite flap. Six cases suffered extensive dorsal skin loss, and reconstruction was performed using different types of radial forearm flaps (cutaneous, tendineocutaneous, osteocutaneous, and fascial). Results: Flap survival was obtained in all cases. No vascular complications occurred with free vascularized compound toe transfer. Conclusions: Reconstruction of dorsal thumb defects is imperative and its approach is strictly correlated to type of defect, patient’s requests, and flap alternatives. For defects with nail involvement, the free osteo-onychocutaneous flap harvested from the great toe provides the best aesthetic result in selected young and well-motivated patients. An alternative is represented by the dorsoulnar flap, when the defect is located distally, or the fascial pedicle radial forearm flap, for major dorsal thumb defects, in patients refusing microsurgical reconstruction. The kite flap still represents a feasible solution for medium-size defects with an intact nail.

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.

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.

scholarly journals Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Janni Kjærgaard Thillemann ◽  
Sepp De Raedt ◽  
Torben Bæk Hansen ◽  
Bo Munk ◽  
Maiken Stilling
Keyword(s):  
Experimental Study ◽  
Surgical Techniques ◽  
Distal Radioulnar Joint ◽  
Tendon Graft ◽  
Imaging Method ◽  
Radioulnar Joint ◽  
Clinical Recommendation ◽  
Surgical Methods ◽  
Custom Made ◽  
Stabilizing Effect

Abstract Purpose Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA). Methods In a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5). The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair. Results The DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17). Conclusion In conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions.

Nasal Dermoids in Children: Factors Influencing the Distant Result

2021 ◽  
Author(s):  
Michal Kotowski ◽  
Paulina Adamczyk ◽  
Jaroslaw Szydlowski
Keyword(s):  
Pediatric Patients ◽  
Surgical Techniques ◽  
Intracranial Extension ◽  
Recurrence Rates ◽  
Local Conditions ◽  
Aesthetic Result ◽  
Factors Influencing ◽  
Vertical Incision ◽  
External Rhinoplasty

AbstractThe aim of the study was to present a single institution’s treatment strategy for nasal dermoids and to identify factors influencing distant results. The study covered 24 surgically treated pediatric patients with nasal dermoids (NDs). The medical data concerning demographics, preoperative local inflammations and surgical procedures, form of the abnormality, imaging, surgical techniques, and a role of osteotomies and reconstructions were analyzed. The recurrence rates and distant aesthetic outcomes were assessed. The surgical approach included vertical incision in 21 patients, the external rhinoplasty approach in 2 cases, and bicoronal incision in 1 child. The intracranial extension was confirmed in 6 patients. Seven out of 8 cases with preoperative local inflammations and 3 out of 4 with secondary fistulization were < 4 years old. Nine patients required osteotomies. Three children required reconstruction of the nasal skeleton. None of the distant cosmetic results was described as hideous or unsatisfactory. The incidence of local inflammatory complications is unrelated to the age of the patients. The distant aesthetic result depends on both the initial extent of the disease and preoperative local conditions or interventions. Prompt surgical intervention is highly recommended.

Reconstruction of Fingertip Amputations by Partial Composite Toe Transfer with Short Vascular Pedicle

1998 ◽  
Vol 23 (4) ◽  
pp. 457-464 ◽  
Author(s):  
G. DAUTEL ◽  
D. CORCELLA ◽  
M. MERLE
Keyword(s):  
Nail Plate ◽  
Surgical Reconstruction ◽  
Vascular Pedicle ◽  
Recipient Site ◽  
Fingertip Amputation ◽  
Custom Made ◽  
Initial Injury ◽  
Toe Transfer ◽  
Second Toe ◽  
Exact Amount

Five patients under 15 years-of-age, with a fingertip amputation through the nail plate, were treated with a custom-made partial toe transfer. Two of the patients hid had previous attempts at surgical reconstruction using either a local flap or replantation. Delay between initial injury and reconstruction ranged from 2 to 60 days. In all cases the flap was harvested from the second toe. This “custom-made” compound transfer included the exact amount of pulp, nail bed and bone required for reconstruction. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a digital level on the recipient site. Good to excellent cosmetic results were obtained in all cases, with a nearly normal-looking fingertip. Duration of hospital stay ranged from 4 to 7 days. We recommend this technique for treatment of distal amputation close to the proximal nail fold, in young individuals.

Immediate Reconstruction of a Nonreplantable Thumb Amputation by Great Toe Transfer

2009 ◽  
Vol 124 (6) ◽  
pp. 2198-2199 ◽  
Author(s):  
Jörn Redeker ◽  
Christine Radtke ◽  
Alexander Handschin ◽  
Peter M. Vogt
Keyword(s):  
Great Toe ◽  
Immediate Reconstruction ◽  
Thumb Amputation ◽  
Toe Transfer

scholarly journals Glans Resurfacing in Carcinoma in situ of the Penis: A Case Report

2020 ◽  
pp. 1-5
Author(s):  
Raquel Catarino ◽  
André Cardoso ◽  
Carlos Ferreira ◽  
Diogo Pereira ◽  
Tiago Correia ◽  
...  
Keyword(s):  
Case Report ◽  
Carcinoma In Situ ◽  
Penile Cancer ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Disease Recurrence ◽  
Premalignant Lesions ◽  
Surgical Approaches ◽  
Aesthetic Result

Aims: Penile cancer is an uncommon malignancy in Western countries. There are known premalignant lesions that can progress to invasive penile cancer, namely carcinoma in situ (CIS) of the glans. Treatment options for this disease include topical chemotherapy and laser ablation, but the published literature demonstrates limited efficacy for these approaches. Surgical techniques with penile-preserving approaches are performed with the goal of removing the entire tumor and preserving as much of penis as possible. There are no large, randomized studies comparing treatment options for these lesions, and reports concerning the surgical approaches are scarce. Presentation of Case: In this study, we present a case report of a patient with CIS of the glans penis surgically treated with glans resurfacing. Discussion and Conclusions: There were no complications during follow-up, and after 20 months, the patient has no evidence of disease recurrence, has preserved urinary and erectile functions and is currently satisfied with the cosmetic appearance. CIS treatment with glans resurfacing allows the maintenance penile length and function with a good aesthetic result without compromising oncologic control. This approach also allows an accurate staging of the disease and assessment of the treatment efficacy.

The State-of-the-Art in Tissue Exchange

2004 ◽  
Author(s):  
W. Mark Saltzman
Keyword(s):  
Wound Repair ◽  
Surgical Techniques ◽  
Immunosuppressive Drugs ◽  
Tissue Loss ◽  
Cartilage Defects ◽  
Past Century ◽  
Burn Victims ◽  
Differentiated Cells ◽  
Chondrocyte Implantation ◽  
Skin Loss

It is an impressive spectacle. Multicellular organisms—from fruitflies to humans—emerge from a single cell through a coordinated sequence of cell division, movement, and specialization. Many of the fundamental mechanisms of animal development are known: differentiated cells arise from less specialized precursor or stem cells, cells organize into functional units by migration and selective adhesion, and cell-secreted growth factors stimulate growth or differentiation in other cells. Despite extensive progress in acquiring basic knowledge, however, therapeutic opportunities for patients with tissue loss due to trauma or disease remain extremely limited. Degeneration within the nervous system can reduce the quality and length of life for individuals with Parkinson’s disease. Inadequate healing can cause various problems, including liver failure after hepatitis infections, as well as chronic pain from venous leg ulcers and severe infections in burn victims. The symphony of development is difficult to conduct in adults. Tissue or whole-organ transplantation is one of the few options currently available for patients with many common ailments including excessive skin loss and artery occlusion. During the past century, many of the obstacles to transplantation were cleared: immunosuppressive drugs and advanced surgical techniques make liver, heart, kidney, blood vessel, and other major organ transplantations a daily reality. But transplantation technology has encountered another severe limitation. The number of patients requiring a transplant far exceeds the available supply of donor tissues. New technology is needed to reduce this deficit. Some advances will come from individuals trained to synthesize basic scientific discoveries (for example, in developmental biology) with modern bioengineering principles. Tissue engineering grew from the challenge presented by tissue shortage. Tissue engineers are working to develop new approaches for encouraging tissue growth and repair; these approaches are founded on basic science of organ development and wound healing. A few pioneering efforts are already being tested in patients; these include engineered skin equivalents for wound repair, transplanted cells that are isolated from the immune system by encapsulation in polymer membranes for treatment of diabetes, and chondrocyte implantation for repair of articular cartilage defects.

A new species of Phrynopus from Departamento Cusco, southern Peru(Anura: Brachycephalidae)

Zootaxa ◽  
2007 ◽  
Vol 1618 (1) ◽  
pp. 61-68 ◽  
Author(s):  
JUAN C. CHAPARRO ◽  
IGNACIO DE LA RIVA ◽  
JOSÉ M. PADIAL ◽  
JOSÉ A. OCHOA ◽  
EDGAR LEHR
Keyword(s):  
New Species ◽  
Tympanic Membrane ◽  
Cloud Forest ◽  
Medium Size ◽  
Dorsal Skin ◽  
Southern Peru ◽  
Upper Limits ◽  
Ventral Skin ◽  
A New Species

We describe a new species of Phrynopus (Anura: Brachycephalidae) from two close localities at the upper limits of cloud forest in the southern Peruvian Departamento Cusco, between 3555–3950 m a.s.l. The new species is characterized by having medium size (maximum snout-vent length 23.4 mm), dentigerous processes of vomers absent, tympanic membrane inconspicuous, dorsal skin coarsely shagreen in life, dorsolateral folds, ventral skin areolate, dorsum tan, venter bold black with conspicuous bluish-gray spots, and a bluish-white iris.

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