scholarly journals First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shi-Ming Feng ◽  
Jia-Ju Zhao ◽  
Filippo Migliorini ◽  
Nicola Maffulli ◽  
Wei Xu
Keyword(s):  
Patient Satisfaction ◽  
Digital Nerve ◽  
Reconstruction Procedure ◽  
Level Of Evidence ◽  
Cold Intolerance ◽  
Dorsal Branch ◽  
Dorsal Metacarpal Artery ◽  
Retrospective Comparative Study ◽  
First Dorsal Metacarpal Artery

Abstract Background The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. Methods This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. Results All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05). Conclusion There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. Level of evidence: Level III, retrospective comparative study.

Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects

2015 ◽  
Vol 41 (2) ◽  
pp. 177-184 ◽  
Author(s):  
H. Wang ◽  
C. Chen ◽  
J. Li ◽  
X. Yang ◽  
H. Zhang ◽  
...  
Keyword(s):  
Island Flap ◽  
Control Group ◽  
Terminal Branch ◽  
Level Of Evidence ◽  
Mean Values ◽  
Dorsal Branch ◽  
Dorsal Metacarpal Artery ◽  
Sensory Reconstruction ◽  
First Dorsal Metacarpal Artery

Restoration of tactile sensation after reconstruction of a thumb pulp defect is import for hand function. We describe our clinical experience using a modified first dorsal metacarpal artery island flap innervated by the radial dorsal branch of the proper digital nerve and the terminal branch of the superficial radial nerve in 20 consecutive cases. The results were compared with 25 patients treated by the conventional Foucher’s first dorsal metacarpal artery flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes–Weinstein monofilament testing. All flaps survived uneventfully in both groups. At the final follow-up, the mean values for static two-point discrimination and Semmes–Weinstein monofilament testing in the study group were significantly different from the values in the control group. The modified first dorsal metacarpal artery island flap provides a reliable and simple option for sensory reconstruction of thumb pulp defects. Level of evidence: Therapeutic, level III

Modified Littler flap for sensory reconstruction of large thumb pulp defects

2018 ◽  
Vol 43 (5) ◽  
pp. 546-553 ◽  
Author(s):  
Hui Wang ◽  
Xiaoxi Yang ◽  
Chao Chen ◽  
Bin Wang ◽  
Wei Wang ◽  
...  
Keyword(s):  
Donor Site ◽  
Ring Finger ◽  
Middle Finger ◽  
Donor Site Morbidity ◽  
Digital Nerve ◽  
Level Of Evidence ◽  
Dorsal Branch ◽  
Ulnar Aspect ◽  
Monofilament Test

The Littler flap has been widely used to repair large pulp defects of the thumb; however, several complications have occurred frequently. In order to reduce these issues, the modified Littler flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve from the ulnar aspect of the middle finger or the radial aspect of the ring finger were devised in 16 consecutive cases. At the donor site, the defect of the proper digital nerve was repaired with a nerve graft from the proximal portion of the ipsilateral dorsal branch of the proper digital nerve. At the final follow-up, the scores for the static two-point discrimination test, Semmes–Weinstein monofilament test and total active motions in both recipient and donor fingers were nearly normal. This modified Littler flap provides a simple and reliable alternative for treatment of large defects of the thumb pulp with low donor-site morbidity. Level of Evidence: IV

The Dorsal Middle Phalangeal Finger Flap

1997 ◽  
Vol 22 (3) ◽  
pp. 362-371 ◽  
Author(s):  
P. LEUPIN ◽  
J. WEIL ◽  
U. BÜCHLER
Keyword(s):  
Digital Artery ◽  
Digital Nerve ◽  
Venous Flow ◽  
Cold Intolerance ◽  
Dorsal Vein ◽  
Neurovascular Flap ◽  
Dorsal Branch ◽  
Flow Through ◽  
A Prospective Study

The dorsal middle phalangeal finger (DMF) flap is a (neuro)vaseular island flap based on one palmar proper digital artery, its venae comitantes (and/or a separate dorsal vein) and the dorsal branch(es) of the palmar digital nerve. The main nerve supply of the donor finger is left undisturbed. The flap may be raised on a short antegrade, long antegrade or a retrograde pedicle, and used as a free, arterial and/or venous flow-through or neurovascular flap. In a prospective study (mean follow-up of 50 months), the results of 43 DMF flaps were analysed. All flaps survived, retained patency of their vascular pedicles and fulfilled their goals. Neurovascular flaps provided sensate coverage at the S3+ level with static 2-point discrimination values of about 10 mm. Dissection between the proper digital nerve and the rest of the neurovascular bundle induced a 5% incidence of cold intolerance and a 12% occurrence of S3+ hypaesthesia. Advantages, drawbacks and indications of DMF flaps are outlined.

scholarly journals Soft tissue reconstruction of low voltage electric burn injuries of the thumb and first web space by the first dorsal metacarpal artery island flap: a three-year study from Eastern India

2020 ◽  
Vol 7 (4) ◽  
pp. 1082
Author(s):  
Madhumita Gupta ◽  
Prabir Kumar Jash
Keyword(s):  
Soft Tissue ◽  
Low Voltage ◽  
Burn Injuries ◽  
Soft Tissue Defects ◽  
Dorsal Metacarpal Artery ◽  
Web Space ◽  
Electric Burns ◽  
Tissue Defects ◽  
First Dorsal Metacarpal Artery

Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

scholarly journals Isolated Intermetatarsal Ligament Release as Primary Surgical Management for Morton’s Neuroma

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0013
Author(s):  
Mohamed Abdelaziz ◽  
Kathryn Whitelaw ◽  
Gregory Waryasz ◽  
Daniel Guss ◽  
Anne Johnson ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Nerve Transection ◽  
Digital Nerve ◽  
Morton’S Neuroma ◽  
The Past ◽  
Symptom Exacerbation ◽  
Morton's Neuroma ◽  
Web Space ◽  
Neuroma Formation

Category: Midfoot/Forefoot Introduction/Purpose: While the precise pathoetiology of Morton’s neuroma remains unclear, nerve inflammation as a result of chronic entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional surgical management involved common digital nerve transection with neuroma excision, but this procedure risks unpredictable formation of a stump neuroma and potential worsening of symptoms. Accordingly, the senior author has over the past six years espoused isolated IML release and common digital nerve decompression in lieu of nerve transection or neuroma excision as an alternative treatment strategy. We hypothesized that IML release offers effective pain relief and high patient satisfaction level as a surgical treatment for recalcitrant Morton’s neuroma without the risk of stump neuroma formation or symptom exacerbation. Methods: Medical records for all consecutive patients treated surgically with isolated single interspace IML release for symptomatic and recalcitrant Morton’s neuroma over a four year period at a large academic medical center were examined. Any adult patient with clinically diagnosed Morton’s neuroma who had failed at least three months of conservative treatment and who then underwent single-webspace IML decompression were included. Any patient who had less than three months postoperative follow up, had undergone revisional neuroma surgery, or had undergone additional procedures at the time of the IML release were excluded. Overall patient satisfaction as well as pre- and post-operative Visual Analog Pain Scale (VAS) assessments were recorded for all patients. Results: Eleven patients underwent isolated, single interspace IML decompression for Morton’s neuroma over this time frame. One of these patients had a neuroma localized to the second web space and 10 were localized to the third web space. Average follow-up was 10.8± 9 (3-32) months (Table 1). VAS pain scores averaged 6.4 ± 1.9 (4-9) preoperatively and decreased to an average of 1.5 ± 1.6 (0-5) at final follow up (P = 0.003). All patients reported significant pain improvement and an overall satisfaction with the procedure (would undergo it again). No patients returned to the operating room, there were no postoperative infection nor worsening of pain, and no other complications were reported. Conclusion: Isolated single interspace IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief and overall patient satisfaction, with few complications and no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. The authors’ collective experience with this approach has been positive enough over the past six years to result in the entire abandonment of the practice of neuroma excision in this patient population.

scholarly journals Treatment of Severe Ulnar Instability of the MCP Joint Improves Function in LRTI Arthroplasty for Osteoarthritis of the Thumb CMC Joint

2019 ◽  
Vol 09 (02) ◽  
pp. 105-115
Author(s):  
Johanna Wirth ◽  
Eva-Maria Baur
Keyword(s):  
Patient Satisfaction ◽  
Strength Function ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Metacarpal Bone ◽  
Control Group ◽  
Level Of Evidence ◽  
Pinch Grip ◽  
Significant Difference ◽  
Retrospective Comparative Study

Abstract Background Comorbidity in the metacarpophalangeal joint (MCPj) of the thumb, i.e., hyperextension or ulnar collateral instability, could affect the outcome of arthroplasty in the thumb carpometacarpal joint (CMCj). Objective In a retrospective study, we evaluated the effect of arthrodesis of the MCPj for thumbs with unstable MCPj and simultaneous ligament reconstruction tendon interposition (LRTI) arthroplasty for the CMCj in terms of strength, function, and patient satisfaction. Patients and Methods A total of 69 thumbs treated with a LRTI arthroplasty of the CMCj were included. In 14 of those cases, an arthrodesis of the MCPj was performed as well. In 12 thumbs, both procedures were done simultaneously; in one case MCPj arthrodesis followed LRTI arthroplasty, whereas one patient already had MCPj arthrodesis at time of LRTI arthroplasty. Those 14 thumbs were compared with the control group of 55 thumbs who had only undergone LRTI. At a mean follow-up of 4 to 5 years (mean 54 [10–124] months) postoperative assessments included range of motion (ROM) of the CMC, MCP, and interphalangeal (IP) joint of the thumb, as well as any instability of the MCPj. Pinch and grip strength were examined, also the visual analogue scale (VAS), patient satisfaction, QuickDASH, PRWE-Thumb, and the Kapandji's Opposition Score. Radiologically, proximalization of the first metacarpal bone was measured. Student's t-test was used to determine significance, p < 0.05 was considered significant. Results Additional arthrodesis of the MCPj provided no significant difference of function in thumbs that only had a hyperextension-instability. However, in thumbs with marked ulnar instability, stronger pinch-grip was obtained with arthrodesis, compared with only LRTI. Conclusion In patients with advanced painful thumb CMCj osteoarthritis, we recommend (simultaneous) arthrodesis of the MCPj, to allow a stable thumb grip if there is additional marked ulnar collateral ligament instability. Level of Evidence This is a Level III, retrospective comparative study.

A Comparative Study of the Heterodigital Neurovascular Island Flap in Thumb Reconstruction, with and without Nerve Reconnection

1994 ◽  
Vol 19 (5) ◽  
pp. 552-559 ◽  
Author(s):  
R. ADANI ◽  
P. B. SQUARZINA ◽  
C. CASTAGNETTI ◽  
A. LAGANÁ ◽  
G. PANCALDI ◽  
...  
Keyword(s):  
Donor Site ◽  
Functional Results ◽  
Flap Reconstruction ◽  
Hypertrophic Scarring ◽  
Digital Nerve ◽  
Thumb Reconstruction ◽  
Cold Intolerance ◽  
Scar Contracture ◽  
Sensory Acuity

41 heterodigital neurovascular island flaps were used to cover defects of the tactile pad of the thumb in 17 years. With an average follow-up of 75.5 months, 30 patients were reviewed. 17 were treated by the original Littler technique and 13 were treated with the same flap reconstruction but with division of the digital nerve innervating the flap and re-anastomosis of this nerve to the proximal nerve end of the ulnar digital nerve of the thumb. Good aesthetic and functional results were achieved in both groups. Sensory acuity did not appear to decrease with time. The nerve reconnection technique solves the “double sensibility” phenomenon (present in 41.1% of our cases treated by the original technique), but two-point discrimination is less than that achieved by the Littler technique. Most complaints were related to the donor site such as hypertrophic scarring or scar contracture and cold intolerance, but these did not cause any real functional impairment.

The proximal first dorsal metacarpal artery free flap for reconstruction of complex digital defects

2012 ◽  
Vol 38 (4) ◽  
pp. 399-404 ◽  
Author(s):  
P. Hyza ◽  
T. Kubek ◽  
J. Vesely ◽  
L. Drazan ◽  
U. Choudry
Keyword(s):  
Patient Satisfaction ◽  
Surgical Technique ◽  
Free Flap ◽  
Primary Closure ◽  
Donor Site ◽  
Free Flaps ◽  
Outcome Data ◽  
Patient Demographics ◽  
Dorsal Metacarpal Artery ◽  
First Dorsal Metacarpal Artery

We describe our experience and outcome with the ‘Proximal first dorsal metacarpal artery free flap’. Ten consecutive cases utilizing the proximal first dorsal metacarpal artery free flap for complex digital defects were studied. Surgical technique, patient demographics, and flap outcome data were collected. Patient satisfaction was analysed using a questionnaire. All defects healed successfully with no loss of free flaps. The short-pedicle proximal first dorsal metacarpal artery free flap enables primary closure of the donor site up to 2 cm of width (in nine of the ten donor sites). The flap is a reliable and versatile alternative in selected cases of complex digital injuries.

Does nerve repair influence the outcome of reconstruction of a digital nail defect using a free composite flap taken from the great toe?

2014 ◽  
Vol 40 (6) ◽  
pp. 583-590 ◽  
Author(s):  
X. Zhang ◽  
C. Chen ◽  
Y. Li ◽  
X. Shao ◽  
W. Guo ◽  
...  
Keyword(s):  
Nerve Repair ◽  
Donor Site ◽  
Digital Nerve ◽  
Great Toe ◽  
Dorsal Branch ◽  
Mean Size ◽  
The Mean ◽  
Repair Group ◽  
Composite Flap

We describe reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, comparing the outcome in patients in whom neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger was performed to those in which no nerve repair was made. From January 2002 to March 2009, 47 patients with traumatic fingernail defects were treated. Twenty-two patients before February 2005 had no nerve repair and subsequently 25 patients had nerve repair. The mean size of the germinal matrix and sterile matrix defects was 9 × 8 mm, and the mean size of the nail bed flaps was 9 × 9 mm. The mean length of the arteries used for the flap was 2.2 cm. Outcomes were rated. In the nerve repair group, full flap survival was achieved in 24 patients. At the mean follow-up period of 25 months, there were 12 excellent, seven very good, four good, and two fair results. In the comparison group without nerve repair, there were seven excellent, four very good, four good, five fair, and two poor results. Donor site morbidities were similar in both groups. The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger. Innervated nail flap reconstructions tended to show better outcomes than those in which no nerve repair was performed. There is no difference in function or donor site between those in whom the nerve was repaired compared with those in whom it was not repaired.

Effect of Bipartite Hallucal Sesamoid on Hallux Valgus Surgery

2017 ◽  
Vol 38 (6) ◽  
pp. 634-640 ◽  
Author(s):  
Young Hwan Park ◽  
Chan Dong Jeong ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Hallux Valgus ◽  
Study Cohort ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Chevron Osteotomy ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
Retrospective Comparative Study

Background: Bipartite hallucal sesamoids are often found in patients with hallux valgus. However, it is unknown whether bipartite hallucal sesamoids affect the results of hallux valgus surgery or not. The purpose of the present study was to evaluate the outcomes of chevron osteotomy for hallux valgus with and without bipartite hallucal sesamoid. Methods: A total of 152 patients (168 feet) treated with distal or proximal chevron osteotomy for hallux valgus constituted the study cohort. The 168 feet were divided into 2 groups: bipartite hallucal sesamoid (31 feet) and without bipartite hallucal sesamoid (137 feet). Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), tibial sesamoid position, and first metatarsal length were measured for radiographic outcomes and the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score was measured for clinical outcomes. Results: All radiographic measurements and the AOFAS score showed significant ( P < .05) improvement at the time of final follow-up compared with preoperative measurements in both groups. No significant differences ( P > .05) were found between the 2 groups in terms of HVA, IMA, DMAA, tibial sesamoid position, metatarsal shortening, and AOFAS score on final follow-up. Conclusions: This study suggests that bipartite hallucal sesamoids do not affect the results of hallux valgus surgery. Level of Evidence: Level III, retrospective comparative study.

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