scholarly journals Donor Site Evaluation after Full-Width Metatarsal Transfer for Metacarpal Reconstruction in Severe Thumb Hypoplasia: A Clinical Retrospective Study

2021 ◽  
Author(s):  
Fan Bai ◽  
Lu Liu ◽  
Qiuya Li ◽  
Yunhao Xue ◽  
Chen Yang ◽  
...  
Keyword(s):  
Donor Site ◽  
Parental Satisfaction ◽  
Half Width ◽  
Full Width ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Radiographic Findings ◽  
Type Iiib ◽  
Thumb Hypoplasia ◽  
The Mean

Abstract Background: Pollicization remains the default treatment for severe thumb hypoplasia, while the metatarsal transfer is an effective choice for metacarpal reconstruction, with competitive outcome of reconstructed thumb. However, rare researches focused on the outcome of donor foot of the metatarsal transfer. The purpose of this study was to evaluate the short-term outcome of donor foot after full-width metatarsal transfer for Manske Type IIIB and IV thumb hypoplasia.Methods: Fourteen patients with Manske Type IIIB and IV thumb hypoplasia were enrolled in the study. A full-width metatarsal graft (vascularised, from the second metatarsal or non-vascularised, from the fourth metatarsal) was harvested; an adjacent half-width graft from the third metatarsal was transposed horizontally to replace the donor defect. Objective and subjective evaluations were performed at least 12 months postoperatively. The appearances of the toes and the radiographic findings of the metatarsals were evaluated by two authors, the length and width of the metatarsals were measured on digital anteroposterior radiographs using a paired sample t test. The parental satisfaction was evaluated using a self-administered questionnaire. Results: Among these 14 patients (eight type ⅢB and six type Ⅳ thumbs), there were ten male and four female patients. The mean age at operation was 34.2 months (range: 14 to 127 months), and the mean follow-up was 16.1 months (range: 12 to 30 months). Toe lengthening, toe overriding, and synostosis between the metatarsals were observed in two, two and two patients; toe shortening, toe deviation, metatarsal lengthening and metatarsal angulation were observed in one, one, one and one patient. The lengths of third and fourth metatarsals in donor site were significantly larger than those in contralateral side, while the widths of third and fourth metatarsals were not significantly different between donor and contralateral sides. The mean score in the parental satisfaction questionnaire (full score, 30) was 27.2, (range: 17 to 30), which rated as “good”. Conclusions: Following full-width metatarsal transfer for Type IIIB and IV thumb hypoplasia, transposition of the adjacent half-width metatarsal for donor reconstruction results in minor donor deficit and overall parenteral satisfaction. Level of evidence: Ⅳ

The long-term outcome of simple trapeziectomy

2018 ◽  
Vol 44 (2) ◽  
pp. 146-150 ◽  
Author(s):  
Thomas F. M. Yeoman ◽  
Oliver Stone ◽  
Paul J. Jenkins ◽  
Jane E. McEachan
Keyword(s):  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Sustained Improvement ◽  
Patient Reported ◽  
The Mean ◽  
Joint Arthritis

The aim of this study was to investigate the long-term outcome of simple trapeziectomy by a single surgeon and to compare this with pre-operative function. Two hundred and five patients completed the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) and the EuroQoL five-dimensional questionnaire (EQ-5D) scores at a mean of 8.2 (range 3.5–17) years after simple trapeziectomy. There were no pre-operative scores available, so case controls were selected from our prospective database to compare pre- and post-operative patient-reported outcome measures. The mean QuickDASH score of the post-operative matched group was 37 (SD 17.0) and the mean EQ-5D was 0.56 (SD 0.31). The mean QuickDASH score of the pre-operative group was 54 (SD 17.0). The mean difference in QuickDASH between the pre- and post-operative groups was 17 (95% CI: 8 to 26, p = 0.0003). This study demonstrated a significant and sustained improvement in patient-reported function after simple trapeziectomy. It supports that simple trapeziectomy is a simple, safe and effective treatment for advanced trapeziometacarpal joint arthritis. Level of evidence: IV

An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

2020 ◽  
Vol 45 (8) ◽  
pp. 842-848
Author(s):  
Satoshi Usami ◽  
Kohei Inami ◽  
Yuichi Hirase ◽  
Hiroki Mori
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Soft Tissue Reconstruction ◽  
Level Of Evidence ◽  
Tissue Reconstruction ◽  
The Mean ◽  
Lost To Follow Up ◽  
Pulp Repair ◽  
Sensory Reinnervation

We present outcomes of using a perforator-based ulnar parametacarpal flap in 25 patients for digital pulp defects. These included 17 free transfers to the thumb, index, middle and ring fingers and eight reverse pedicled transfers to the little fingers. This flap includes a dorsal sensory branch of the ulnar nerve, which was sutured to the digital nerve in all transfers. Each flap had one to three reliable perforators (mean 0.44 mm diameter) to the ulnar parametacarpal region and contained at least one perforator within 2 cm proximal to the palmar digital crease. All the 25 flaps survived completely. Twenty-two patients were followed for 15 months (range 12 to 24), and three were lost to follow-up. The mean static and moving two-point discrimination of the flap was 7 mm and 5 mm, respectively. At the donor site, sensory reinnervation was acceptable. We conclude that ulnar parametacarpal perforator flaps offer sensate, thick and glabrous skin for finger pulp repair, all in a single operative field. Level of evidence: IV

Gender Disparity between Donor Sites of the Trochlea Used for Autologous Osteoarticular Transfer: An MRI Analysis

2019 ◽  
Vol 33 (04) ◽  
pp. 357-364
Author(s):  
Kelly M. Rogers ◽  
Daniel C. Berman ◽  
Justin W. Griffin ◽  
Kevin F. Bonner
Keyword(s):  
Standard Deviation ◽  
Trochlear Dysplasia ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Gender Disparity ◽  
Measurement Tool ◽  
Level Of Evidence ◽  
Osteochondral Autograft Transfer ◽  
Males And Females ◽  
The Mean

AbstractThe purpose of this study was to assess potential gender differences in size of the lateral and medial trochlea of the male and female knee as well as the variation within gender of potential osteochondral autograft transfer (OAT) donor site area. Two hundred and twelve skeletally mature patients, 106 males and 106 females, who underwent a 3T magnetic resonance imaging of the knee for a variety of indications were utilized for analysis. Exclusion criteria included degenerative arthritis, trochlear dysplasia, and poor image quality. Medial and lateral femoral trochlear cartilage width was obtained using a linear radiologic measurement tool. Widths were measured from a reproducible anatomic location representing the maximal trochlear dimension in a region where donor plugs are commonly harvested. Trochlear width was also plotted as a function of patient height. Statistical analysis was performed using a two-sample t-test. The mean and standard deviation of the lateral trochlear cartilage width (mm) for males and females were 23.38 +/− 2.14 and 20.44 +/− 2.16, respectively (p < 0.00001). The mean and standard deviation of the medial trochlear cartilage width (mm) for males and females were 14.16 +/− 2.17 and 11.78 +/− 2.03, respectively (p < 0.00001). The overall range in trochlear width for both the lateral and medial sides was 22.22 and 19.73 mm for males and females, respectively. A graft measuring 10 mm could represent as little as 34% of the lateral trochlea in males versus as much as 65% in females. Our results indicate that donor OAT plug diameter relative to available trochlear cartilage width will vary significantly both between genders and individual patients. Trochlear width variability and its potential implications on donor site morbidity may be an important consideration when contemplating osteochondral plug harvest for OAT or other indications. The level of evidence is IV.

Type IIIB and IV hypoplastic thumb reconstruction with non-vascularized fourth metatarsal

2020 ◽  
Vol 45 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Bo Liu ◽  
Shanlin Chen ◽  
Esther Ching San Chow ◽  
Pengcheng Li ◽  
Kun Liu ◽  
...  
Keyword(s):  
Hand Function ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Pinch Strength ◽  
Reconstruction Method ◽  
Level Of Evidence ◽  
Type Iv ◽  
Type Iiib ◽  
Rotational Flap ◽  
Staged Reconstruction

We treated 16 patients with 17 hypoplastic thumbs (eight Type IIIB and nine Type IV) using a non-vascularized fourth metatarsal transfer with a rotational flap and multi-staged reconstruction. The average age at the first operation was 24 months. The average follow-up time was 46 months. All patients achieved reasonable hand function and were able to use the reconstructed thumb to grip small and large objects. The operated thumb achieved an average Kapandji score of 6.7 and average pinch strength of 0.9 kg. There were two cases of graft nonunion. All parents are satisfied with the function and appearance of the reconstructed thumb and donor foot. We conclude that non-vascularized fourth metatarsal transfer is a feasible reconstruction method for patients with Types IIIB and IV hypoplastic thumbs. The reconstruction allows for the preservation of a 5-digit hand with reasonable function and appearance and minimal donor site morbidity, although long-term growth of the metatarsals still need to be monitored. Level of evidence: IV

Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger

2014 ◽  
Vol 40 (4) ◽  
pp. 392-400 ◽  
Author(s):  
H. Y. Erken ◽  
I. Akmaz ◽  
S. Takka ◽  
A. Kiral
Keyword(s):  
Retrospective Review ◽  
Index Finger ◽  
Donor Site ◽  
Level Of Evidence ◽  
Reliable Technique ◽  
Flap Loss ◽  
Discrimination Testing ◽  
The Mean ◽  
Donor Site Complication

We performed a retrospective review of 12 patients with dorsal oblique and transverse amputations of the distal thumb who were treated with a volar cross-finger flap from the index finger. The mean patient follow-up period was 28 months postoperatively (range: 19–43 months). There were no instances of flap loss, infection, or donor site complication in our series. The mean Semmes–Weinstein monofilament testing scores on the injured thumb and the donor site were 0.65 g (range: 0.16–2 g) and 0.51 g (range: 0.16–1 g), respectively. The mean 2-point discrimination testing scores on the injured thumb and the donor site were 4.5 mm (range: 3–8 mm) and 4.3 mm (range: 3–7 mm), respectively. This study suggests that the volar cross-finger flap using the index finger is a reliable technique in repairing dorsal oblique and transverse amputations of the distal thumb. Type of study/level of evidence: Therapeutic IV

Radioscapholunate fusion with triquetrum and distal pole of scaphoid excision: long-term follow-up

2017 ◽  
Vol 43 (2) ◽  
pp. 168-173 ◽  
Author(s):  
Ngoc B. Ha ◽  
Joideep Phadnis ◽  
Simon B. M. MacLean ◽  
Gregory I. Bain
Keyword(s):  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Distal Pole ◽  
Long Term Follow Up ◽  
Radioscapholunate Fusion ◽  
The Mean

The purpose of this study was to assess the long-term outcomes of radioscapholunate fusion, with and without distal pole of scaphoid excision and excision of the triquetrum. These compromised three operative groups. Seventeen patients were identified with a minimum of 10 years follow-up, with a mean of 15 years (range 10–19). Fifteen of the 17 patients were satisfied with their outcome. Two were converted to total wrist fusion. The mean outcomes scores were; pain visual analogue scale score 2.1/10, Quick Disabilities of the Arm, Shoulder, and Hand 29 and Modified Mayo Wrist score 60. Patients with excision of the triquetrum had a mean radial–ulnar arc increase of 10° compared with the other two groups, but this was not statistically significant. The mean space for the scaphocapitate joint was 1.7 mm and lunocapitate joint was 1.3 mm at latest follow-up. Close adherence to the indications and surgical technique provided a sustainable good clinical outcome. Patients who obtained a good result at 2 years were likely to achieve a good long-term outcome. Level of evidence: IV

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 Reversed vascularized second metatarsal flap for reconstruction of Manske type IIIB and IV thumb hypoplasia with reduced donor site morbidity

2019 ◽  
Vol 132 (21) ◽  
pp. 2565-2571 ◽  
Author(s):  
De-Di Tong ◽  
Le-Hao Wu ◽  
Peng-Cheng Li ◽  
Yan-Bo Rong ◽  
Bo Liu ◽  
...  
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Type Iiib ◽  
Thumb Hypoplasia ◽  
Second Metatarsal

scholarly journals Clinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093779
Author(s):  
Lu Bai ◽  
Siyao Guan ◽  
Sanbiao Liu ◽  
Tian You ◽  
Xiaoxiao Xie ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Donor Site ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Osteotomy Site ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
No Donor ◽  
Second Look ◽  
The Mean

Background: Osteochondral lesions of the talus (OLTs) with large subchondral cysts are challenging to treat. Purpose: To determine the safety and efficacy of autologous chondral grafting and malleolus osteotomy for treating OLTs associated with large subchondral cysts. Study Design: Case series; Level of evidence, 4. Methods: A total of 19 patients underwent autologous chondral grafting and malleolus osteotomy. We obtained the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, and magnetic resonance observation of cartilage repair tissue (MOCART) scores at 1 and 2 years postoperatively. The International Cartilage Repair Society (ICRS) score was collected 2 years postoperatively during second-look arthroscopic surgery. Results: In all patients, the osteotomy site healed without nonunion or malunion. Only 1 patient developed joint space narrowing. No donor site complications occurred. The mean AOFAS score significantly improved at 1 year (from 72.8 ± 4.8 preoperatively to 93.7 ± 4.6; t = –13.708; P < .0001). The 1- and 2-year AOFAS scores were similar ( t = –0.755; P = .455), indicating stable improvement. The mean VAS score significantly decreased at 1 year (from 4.68 ± 0.67 preoperatively to 0.47 ± 0.69; t = 18.974; P < .0001). The 1- and 2-year VAS scores were similar ( t = –0.705; P = .455), as were the 1- and 2-year MOCART scores (64.2 ± 7.5 vs 67.4 ± 7.3, respectively; t = –1.312; P = .198). The ICRS scores were as follows: 7 points (abnormal) in 1 (5.2%) patient, 8 to 11 points (nearly normal) in 9 (47.4%) patients, and 12 points (normal) in 9 (47.4%) patients. Conclusion: Osteotomy combined with autologous osteochondral transplantation provided good functional outcomes in patients with OLTs and large subchondral cysts. Second-look arthroscopic surgery showed healthy cartilage healing.

scholarly journals Radiographic evaluation of the tibiotarsal joint in patients with ipsilateral triple arthrodesis

2019 ◽  
Vol 13 (1) ◽  
pp. 35-41
Author(s):  
Bruno De Carvalho Marques ◽  
Isnar Moreira Castro Junior
Keyword(s):  
Initial Period ◽  
Case Series ◽  
Onset Time ◽  
Radiographic Evaluation ◽  
Triple Arthrodesis ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Evolution Time ◽  
Kellgren And Lawrence ◽  
The Mean

Objective: This study radiographically evaluated the tibiotarsal joints of patients receiving ipsilateral triple arthrodesis and analyzed the effects of this procedure over the short and medium terms. Methods: A total of 150 triple arthrodesis procedures were performed between 2010 and 2015, and 56 patients (62 operated feet) participated in this study. The ankles were radiographically evaluated at the following time points: the initial or preoperative period, 1 year after the operation, and 3 to 5 years after the operation. The presence of arthrosis according to the Kellgren and Lawrence (K&L) scale and the onset time of secondary arthrosis worsening were observed. Results: During the initial period, 31 ankles (50%) presented with no clear signs of arthrosis. Tibiotarsal arthrosis presented with a worsening of 1 degree in 13 ankles 1 year after surgery (28.3%). Three to 5 years after surgery, a 1-degree worsening of 21 ankles (55.2%) was observed; 15.8% (n=6) of the ankles had a worsening of arthrosis greater than or equal to 2 degrees; and 11 ankles (29%) had no worsening or onset of tibiotarsal arthrosis. The worsening or onset of tibiotarsal arthrosis occurred an average of 22 months after the procedure. The mean postoperative evolution time was 32.4 months for those who presented with an arthrosis worsening of only 1 degree. Those who presented with a worsening of tibiotarsal arthrosis of 2 or more degrees had an average postoperative evolution time of 43.7 months. Conclusion: Radiographic findings strengthen the concept of arthrosis formation following triple arthrodesis in the tibiotarsal joint, even over the short and medium terms. Level of Evidence IV; Therapeutic Studies; Case Series.  

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