Extensor indicis proprius transfer for the abducted small finger

PURPOSE: Persistent abduction of the small finger has usually been treated by transfer of the extensor digiti minimi muscle. However, anatomic variations of the extensor system may limit the potential for a successful extensor digiti minimi transfer. Therefore, we evaluated the outcomes of an alternative reconstruction method for the abducted small finger using an extensor indicis proprius (EIP) transfer. METHODS: We performed 8 EIP transfers in 8 patients with persistent, flexible abduction posturing of the small finger. The primary etiology of the deformity was incomplete motor reinnervation after surgeries for ulnar neuropathy in 6 patients, rupture of the third palmar interosseous musculotendinous unit in 1 patient, and intrinsic muscle fibrosis in 1 patient. The EIP was elongated by splitting the tendinous portion and was transferred to the distal and radial part of the extensor hood. Surgical outcomes were assessed by comparing preoperative and postoperative active adduction and abduction motion of the 2 ulnar digits. RESULTS: At the mean follow-up of 23 months, the average adduction angle improved from 19 degrees to 1 degrees postoperatively. In terms of active finger motion, 6 patients showed excellent results, 1 good, and 1 fair, without loss of flexion and extension. No patient had an extension lag or complained of functional deficits of the donor index finger. There was not adverse change to digital function or range of motion for the middle and ring fingers that are crossed by the EIP. CONCLUSIONS: Extensor indicis proprius transfer can be a reliable option for correction of abduction deformity of the small finger, maintaining active abduction and full flexion and extension. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

肱肌肌支移位重建屈指功能的远期疗效

目的报道肌皮神经肱肌肌支移位后的远期疗效。方法对3例行肌皮神经肱肌肌支移位至屈指肌支者,术后随访2年以上,并测定其肌力与肌电。结果2例术前C5、6神经支配肌群良好者(肌力4°,肌电为单纯混合相),术后屈指功能恢复良好(肌力3°,肌电为单纯或单纯混合相)。另1例术前C5、6支配肌群仅个别肌肉良好(肌力3°,肌电为单纯相),术后功能未恢复。结论肱肌肌支的功能状态是影响术后疗效的主要因素,术前C5、6神经根支配的肌群功能状态全面良好者,肱肌肌支移位术后屈指功能恢复良好。     

带蚓状肌的游离足趾再造拇、手指

自１９７２年以来，在游离足趾再造拇、手指手术中，应用足趾蚓状肌与缺损拇、手指蚓状肌残端或关节囊进行缝合的方法共完成手术３００例，由于再造拇、手指的蚓状肌得到修复，既改善了其指间关节屈曲畸形，又防止了掌指关节的过伸。术后随访１－２２年，再造拇、手指的外形及功能均满意。     

带蚓状肌的游离足趾再造拇,手指

自１９７２年以来，在游离足趾再造拇、手指手术中，应用足趾吲状肌与缺损拇、手指蚓状状肌残端或关节囊进行缝合的方法共完成手术３００例，由于再造拇、手指的蚓状肌得到修复，既改善了其指间关节屈曲畸形，又防止了掌指关节的过伸。术后随访１－２２年，再造拇、手指的外表及功能均满意。     

Carpal tunnel syndrome caused by an anomalous muscle belly of the index finger lumbrical

Carpal tunnel syndrome is the most common neuropathy of the upper extremity. It usually occurs without any extrinsic cause; sometimes it is due to aberrant anatomy. A case of an anomalous first lumbrical muscle belly in a 52-year-old woman is described. This patient was operated on without success. During the first intervention, nothing abnormal was observed. Due to the persistence of symptoms, she was operated on again. In the second surgery, an anomalous first lumbrical muscle was detected and resected with a good clinical result. These rare anatomical situations can cause symptoms and should be explored and corrected.     

Thumb and finger reconstruction by toe-to-hand transfer.

Toe transplantation provides a means of restoring a thumb or finger in a single microsurgical procedure with tissues anatomically similar to those lost or absent. Although formidable, these toe transplantation procedures can be accomplished by experienced teams of microsurgeons with a high rate of success.     

Extensor digiti minimi tendon transfer to correct abducted small finger in ulnar dysfunction.

A tendon transfer to correct the abducted posture of the small finger in patients with ulnar nerve dysfunction is described. The extensor digiti minimi is transferred deep to the extensor digitorum communis tendon or junctura tendinae to the small finger and inserted into the radial portion of the extensor hood, correcting the muscle imbalance. Successful results in 10 patients are reported.     

Creation of an artificial smooth muscle rectal sphincter in children

A method for creation of the artificial smooth muscle anal sphincter, which was used in 18 children with high forms of anorectal atresia and in 9 children with associated incompetence of the external and internal anal sphincters developed after repeated operations, severe traumas of the perineum and rectum and suppurative processes, has been developed. The effectiveness of the developed method is shown on the basis of clinical, functional and experimental morphologic methods of investigation.     

Brachialis muscle transfer to reconstruct finger flexion or wrist extension in brachial plexus palsy

PURPOSE: Tendon transfers are a routine procedure used to improve hand function in brachial plexus injuries; however, muscles from forearm donors are not always available for transfer. In this situation a distant muscle may be used. This study describes transfer of the brachialis muscle to the forearm muscles to reconstruct finger flexion or wrist extension in patients with brachial plexus injuries. METHODS: In 6 patients the brachialis muscle was transferred to the flexor digitorum profundus and the flexor pollicis longus to restore finger and thumb flexion with the goal of reconstructing a key pinch and hook grasp. In 3 patients the brachialis muscle was transferred to the extensor carpi radialis brevis to restore wrist extension. The patients were evaluated at regular intervals and had final assessments between 10 and 12 months after surgery. RESULTS: Brachialis transfer to the flexor digitorum profundus and the flexor pollicis longus resulted in active motion with full range of digital flexion in the 2 patients who had partial flexion before surgery, and for the 4 patients who had no finger flexion before surgery it resulted in a pulp-to-palm distance for the middle finger of 1 cm in 3 patients and of 2 cm in 1 patient. A lateral key pinch and hook grasp reconstruction was achieved in all patients. Grasping and lateral pinch strengths averaged 110 and 94 mm Hg, respectively. When the brachialis was transferred to the wrist extensors the patients recovered 20 degrees of active wrist extension against resistance. CONCLUSIONS: Brachialis muscle transfer to the forearm muscle constitutes a valid strategy in the reconstruction of finger and thumb flexion and wrist extension after brachial plexus injury when forearm donor muscles are not available. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

足趾移植再造手指的指腹修整

目的 为了改善足趾移植再造手指常见的外观缺陷,设计一种局部转移皮瓣手术.方法 足趾移植再造的手指末节指腹膨大,手术设计舌形皮瓣转移至中节指腹,以改善再造手指末节膨大、中节狭细的外观.临床应用于9例患者,共21指再造手指.观察术后皮瓣成活、手指外观改善情况,测量手术前后手指关节活动度和两点辨别觉,评价手术效果.结果 随访6～12个月,术后再造手指外观明显改善,中节与末节粗细均匀,长度比例更合理.再造手指手术前后关节活动度和两点辨别觉没有明显变化,皮瓣手术对再造手指的功能没有不良影响.手术没有皮瓣坏死、神经血管损伤、感染等并发症.结论 应用局部转移皮瓣术可以改善足趾移植再造手指的外观.     

The burned small finger.

Postburn deformities are common in the small finger. A boutonniere-like deformity may develop when no injury has been noted in the central slip of the extensor tendon. Attention to the anatomic differences of the fifth digit and principles of graft contraction make this deformity preventable. In the long-standing burn hyperextension deformity of the metacarpophalangeal joint, recurrence of the deformity may occur after reconstruction. Evaluation of extrinsic extensor tightness may indicate an alteration in the soft tissue-to-skeleton relationship. Composite tissue expansion of the tendon and overlying skin graft provides an alternative reconstruction method.     

Functional outcome of extensor carpi radialis longus transfer for finger flexion in posttraumatic flexor muscle loss

PURPOSE: The purpose of this study was to assess the functional outcome after extensor carpi radialis longus (ECRL) transfer for restoration of finger flexion in patients with flexor muscle loss after direct trauma. METHODS: We evaluated 8 patients who had ECRL transfer between 1995 and 2003. Flexion gained was assessed by measuring the digit-to-palm distance (DPD). The grip strength was compared with that of the opposite normal limb. The average follow-up period was 41 months. We compared the results obtained with other modalities of restoration of finger flexion, namely a pedicled latissimus dorsi muscle transfer or a free functioning muscle transfer (FFMT) using the series available in the literature. RESULTS: Four patients had a good result with a DPD of 0 cm in all fingers and an average grip strength of 65% of the opposite hand. Two patients had an average result with a DPD of 1.5, 2, 1.7, and 1.5 cm for the index, middle, ring, and small fingers, respectively, and an average grip strength of 58%; 2 patients had a poor result with a DPD of 5.0, 5.5, 5.0, and 3.0 cm for the index, middle, ring, and small fingers, respectively, and with an average grip strength of 21% of the opposite hand. CONCLUSIONS: The ECRL transfer yields good results if the intrinsic muscles of the hand are functioning, the extensor compartment is uninjured, and the lower third of the forearm where the tendon junction is performed is relatively unscarred. In such instances the range of movement and grip strength achieved are better than a latissimus dorsi muscle pedicle graft and are comparable with a FFMT. This is achieved earlier than the time taken for reinnervation of FFMT and without the attendant risks for flap failure. The ECRL transfer for finger flexor restoration is a more simple alternative that should be considered when possible.     

Total thumb reconstruction by an index finger transposition

A case of total thumb reconstruction after traumatic amputation is described. The reconstruction was carried out as a staged procedure with preliminary application of a pedicle flap, and a normal index finger transposition, followed by opposition transfer using the abductor digiti quinti muscle. Twenty-seven months after the index finger pollicization, the reconstructed thumb had satisfactory function.     

Ipsilateral heterodigital artery transfer for finger revascularization

We report a case of digital revascularization in a child's small finger by using a digital artery from the adjacent uninjured digit. Reconstruction of a defect in the digital artery with a vein graft is technically challenging in a child and has a higher risk of failure due to anastomoses at 2 levels and possible size mismatch. We detail the technique of heterodigital artery transfer from the ring finger to revascularize the small finger with segmental loss of both digital arteries. This technique has not been reported previously and offers a simpler alternative to vein grafting in select situations.