Toe transfer

Today toe-to-hand transfer by micro-anastomoses is one of the most important methods in reconstructing severely injured hands. An experienced surgeon will obtain a survival rate of the transplant in about 94 to 96% of cases. All measures required can be performed by only one operation. The free toe-to-hand transfer guarantees the best functional and aesthetic results so far known.     

Systolic arterial pressure determination by a new pulse monitor technique

The Doppler ultrasound (DUS) technique is a widely accepted non-invasive technique to estimate systolic blood pressure (SBP) accurately in paediatric patients. The DUS has a number of limitations. A new pulse monitor, Mr Pulse (MP), operating on the principle of a finger plethysmograph, was developed to offer an alternative technique to estimate SBP. From 104 paired SBP measurements taken in 16 paediatric patients undergoing general anaesthesia, SBP determined by the MP technique correlated closely with that by the standard DUS technique (r2 = 0.98). Analysis of degree of agreement performed indicated that there was good agreement between SBP obtained by the MP and the DUS techniques. The mean +/- standard deviation of differences in paired SBP values between the two measurement techniques was 0.55 +/- 3.59 mmHg. Mr Pulse is as accurate as the DUS technique in estimating SBP and has the advantage of less critical sensor positioning as it is not subject to electrical interference. It has no electrical hazard.     

双足第二趾移植再造多手指缺损的疗效分析

目的研究双足第二趾移植再造多手指缺损的疗效分析及术后对足部功能及外观的影响。方法根据患者手指缺损情况,选择双足第二趾移植再造,其中再造食指和中指缺损10例,再造拇指与食指缺损9例,再造中指与环指缺损1例,共20例40指。结果 19例再造指全部成活,1例再造坏死1指,再造指经3~24个月随访,平均13个月,再造指痛温觉恢复,两点辨别距离在10~12 mm间,双侧供足外观对称,行走无疼痛,步态正常。结论双足第二趾移植是修复多手指缺损的理想修复方法,且对足部外观及功能影响较小,在多指再造中双足第二趾移植是较为理想的选择。     

Thumb Reconstruction with Toe Transfer

Microsurgical toe transfer has become a gold standard option for amputated thumb reconstruction. It can be used to correct almost any thumb defect. However, for optimal functional and esthetic results, proper initial care, preoperative planning, proper selection of suitable techniques, adjunct or secondary procedures and proper, postoperative rehabilitation are important.     

Toe replantation in the rat

A big toe of a rat was successfully replanted by anastomosing the deep branch of the medial plantar artery and its concomitant vein. The procedure is demonstrated and discussed.     

足趾软骨移植重建手关节功能病人的护理

对42例足趾软骨移植重建手指关节病人术前进行心理护理,充分的关节周围组织及皮肤准备;术后加强生命体征的观察,进行适当的主、被动功能锻炼和出院指导。结果术后关节活动度平均增加43.5°。提示围术期规范护理和康复指导对手术成功至关重要。     

Inherited Accessory Nail of the Fifth Toe Cured by Surgical Matricectomy

BACKGROUND: The inherited accessory nail of the fifth toe is a common condition in the Chinese population. OBJECTIVE: The objective was to demonstrate three lesions in two cases of inherited accessory nail of the fifth toe successfully treated with surgical matricectomy. METHODS: Under local anesthesia and use of tourniquet, the proximal nail fold was incised and the matrix of the accessory nail was exposed and then excised by scalpel surgery. The skin defect left after removal of the lesion was repaired with a rotation flap. RESULTS: Histopathologic examination of the surgical specimens revealed that the matrices of the accessory nails were completely extirpated. No recurrence was found 2 years after operation. CONCLUSION: The inherited accessory nail of the fifth toe was cured by surgical matricectomy.     

Toe transfer for congenital hand defects

Toe-to-hand transfer is a well-established reconstructive option for certain congenital hand anomalies. It is the only technique which can add growth potential to the immature skeleton. Toe transfer is best suited for constriction ring amputations, which have relatively normal proximal anatomy. Transfers should be performed early in life to avoid lack of cortical integration of the new part. Anatomic variations of both hand and foot are often encountered, which influence both operative approach and functional prognosis. Indications, techniques, and complications are reviewed.     

In-Office Distal Symes Lesser Toe Amputation: A Safe,Reliable, and Cost-Effective Treatment of Diabetes-Related Tip of Toe Ulcers Complicated by Osteomyelitis

Diabetes-related tip of lesser toe ulcers have typically been associated with both underlying hammertoe contracture and peripheral neuropathy. The combination of digital deformity and neuropathy commonly results in non-healing, deep sores that frequently become complicated by osteomyelitis. We report on a well-known, but poorly reported, technique for surgical management of non-healing tip of lesser toe ulcers. After approval by the institutional review board, a review was performed of consecutive patients who had undergone office-based distal Symes toe amputation for a non-healing tip of lesser toe ulcer from January 2007 to December 2012. A variety of clinical, laboratory, and radiographic data were collected. A total of 48 consecutive patients (48 toe ulcers) were identified for inclusion in the present study. All patients had ulcers at the time of surgery, and no patient developed repeat ulceration of the involved digit postoperatively. Of the 48 patients, 44 (92%) had hammertoe deformity preoperatively. Also, 30 patients (63%) had positive probe-to-bone results, and 29 (97%) of these patients had culture or histologic findings positive for osteomyelitis. Of the 48 patients (48 ulcers), 73% had positive bone cultures, 69% had positive pathologic findings demonstrating osteomyelitis, and 100% had clean margins. Methicillin-resistant Staphylococcus epidermidis was the most common pathogen isolated (13 of 48, 27%). No patient required additional amputation related to the operative digit. The mean follow-up period was 28.79 months. Our results have shown that in-office distal Symes lesser toe amputation is a safe, reliable, and likely cost-effective treatment of non-healing tip of lesser toe ulcers complicated by osteomyelitis. This office-based procedure allows bone biopsy diagnosis, removes the non-healing ulcer, confirms clear margins regarding the osteomyelitis, and addresses the underlying toe deformity to minimize the chances of repeat ulceration.     

Glomus Tumor of the Great Toe

Glomus tumor is a rare mesenchymal neoplasm composed of cells that resemble the modified perivascular smooth muscle cells (glomus cells) of the normal glomus body. A glomus tumor can appear in any part of the body, although it mostly appears in the extremities, especially in the subungual area of the hand. It has been less commonly reported in the foot. A case of glomus tumor of the pulp of the hallux is described in the present report.     

Toe transfer in congenital hand malformations

Fifty-eight patients with congenital hand abnormalities underwent 65 toe-to-hand transfers. Symbrachydactyly (51 cases) was the most frequent indication. Forty-seven second toe-to-hand transfers were performed in 44 patients. The mean follow-up time was 5.2 years. Two failures occurred in cases in which only one artery was anastomosed; no failures were noted when more than one artery fed the transfer. Two patients with a single second-toe transfer presented with lateral instability of the transferred metatarsophalangeal joint. The mean active range of motion was 38 degrees, with a mean extension lag of 25 degrees. The mean two-point discrimination was 5 mm. Forty-one patients used the transferred toe well, when performing activities of daily living and playing games. Toe-to-hand transfer, prior to the establishment of the grip pattern, facilitates integration of the transfer.