To explore the effectiveness and methods of intervention assistant operation in the treatment of phalanx closed fracture combined with artery crisis. Methods Between August 2002 and December 2008, 24 cases (31 toes) of phalanx closed fracture combined with artery crisis were treated. There were 17 males (22 toes) and 7 females (9 toes), aged from 16 to 62 years (mean, 38 years). The causes of injury included crush and bruise (20 cases), traffic accident (3 cases),and machine twist (1 case). The locations were the first toe (19 toes), the second toe (10 toes), and the third toe (2 toes). The period between injury and hospital ization was 1-10 hours (mean, 6.8 hours). Phalanx angiography was performed by using venous indwell ing needle for dorsal is pedis artery and posterior tibial artery puncture; according to angiography results, proper treatment could be done, then the constrast medium was injected to the artery to observe the blood supply. According to different types and locations of fracture, Kirschner wire and plate were choosen to fix fracture after the blood supply were recovered. Results Two cases (2 toes) received amputation due to necrosis at 4 days and 6 days after interventional therapy, respectively. Twenty-two cases (29 toes) survived. Incision healed primarily in 21 cases. Exudation occurred at wound of 1 case and was cured at 3 weeks after dressing change. Twenty-two cases (29 toes) were followed up 1-6 years (mean, 3.5 years) postoperatively. Two cases (3 toes) felt cool or anaesthesia and could not tolerate even in cold environment. The other toes had no senses of cold pain and paresthesia. Two cases (2 toes) had nonunion and achieved fracture heal ing after grafting bone. The mean union time was 4.5 months (range, 3-6 months) in other cases. Conclusion Intervention assistant operation is an effective measure in the treatment of phalanx closed fracture combined with artery crisis.
Objective To investigate the operative techniques and cl inical results of the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery in repairing donor site defect of forefoot. Methods From March 2005 to October 2007, 15 patients (11 males and 4 females, aged 20-45 years with an average of 33.6 years) with finger defects resulting from either machine crush (12 cases) or car accidents (3 cases) were treated, including 12 cases of thumb defect, 2 of II-V finger defect and 1 of all fingers defect. Among them, 6 cases were reconstructed with immediate toe-to-hand free transplantation after injury, and 9 cases were reconstructed at 3-5 months after injury. The donor site soft tissue defects of forefoot were 6 cm × 4 cm-12 cm × 6 cm in size, and the superficial peroneal neruofasciocutaneousflaps ranging from 10 cm × 4 cm to 14 cm × 6 cm were adopted to repair the donor site defects after taking the escending branch of the distal perforating branch of peroneal artery as flap rotation axis. The donor sites in all cases were covered with intermediate spl it thickness skin grafts. Results All flaps survived and all wounds healed by first intention. All reconstructed fingers survived completely except one index finger, which suffered from necrosis. Over the 6-18 months follow-up period (mean 11 months), the texture and appearance of all the flaps were good, with two-point discriminations ranging from 10-13 mm, and all patients had satisfactory recovery of foot function. No obvious discomfort and neuroma were observed in the skin-graft donor sites. The feel ing of all the reconstructed fingers recovered to a certain degree, so did the grabbing function. Conclusion Due to its rel iable blood supply, no sacrifice of vascular trunks, favorable texture and thickness and simple operative procedure, the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery is effective to repair the donor site defect in forefoot caused by finger reconstruction with free toe-to-hand transplantation.
Objective To discuss the surgical method and effect of repair of damage injury in the hands. Methods Of the 29 cases, 22 were males, 7 were females. Their ages ranged from 15 to 31.The size of defect areas ranged from 18 cm×8 cm to 22 cm×10 cm .Along with dorsalis pedis flap, lateral hemi-pulp flap was takenfrom great toe and first web space flap. The second toe was taken from one footto reconstruct the thumb, second and third toe from another foot was used to reconstruct two fingers. The dorsalis pedis flaps were used to cover palm and dorsum of hand. The lateral hemi-pulp flaps from great toe and first web space flapswere used to reconstruct first web space of hand.Results With the 58 combined flaps, 29 thumbs and 58 fingers were reconstructed. Followups was done for 1 to 8 years.All the thumbsand fingers of 29 hands were reconstructed. Their shape and function were well recovered. Conclusion This new surgical method is effective inpreserving the function of injured hand. The function of the injured hands can be preserved by this surgical method, therefore this method is optimal.
Thumb and finger reconstruction by the method of pedal digit transplantation had been successfully performed in 541 casee from 1977 to 1996, which contained 404 cases of thumbs and 78 cases of fingers. The thumb reconstruction was mainly the simple transplantation of distal phalanx (42 cases) and the compound transplantation of hallucal nail-cutaneous flap with iliac bone segment (16 cases) for the defect of thumbs in degree 1 and 2. The combined transplantation of hallucal nail-cutaneous flap with the joint and tendons of the second toe (34 cases) and the transplantation of the distal part of the second toe (182 cases) for the defect of degree 3 and 4. The combined transplantation of the second pedal digit with its metatarsalphalangeal joint (189 caese) for the defect in degree 5 and 6. The finger reconstruction was performed by anastomosis of the arteries of the digit with those of the fingers for 29 cases with the defect in degree 2 and 3, 60 cases with the defect in degree 4 and 5, and 17 cases with the defect in degree 6. One-hundred and four cases of versels vasiation were found in this group (19 cases with the pedal dorsal artery, 13 cases with the greater saphenous vein and 72 cases with the first dorsal metatarsal artery). The main point of the operation and the treatment of the vessel variations were discussed.
From April 1984 to March 1994, 31 reconstructive thumbs or fingers were followedup, including 16 cases with free neurovascular big toe nail skin flap and frozen preserved phalanxjointtendon composite allografts as well as 15 cases withfree second toe transfer. The method had the advantage of more fingers could bereconstructed and fewer toes would be lost. The decision of the site of reconstruction of finger, the augmentation of narrow web space between the thumb and the index finger, the prevention and treatment of vascular crisis and the degeneration of allogenic joint were discussed. It had been found that preserving the allogenic finger below -30℃ may lower the immunoreaction of the allogenic tissues. It was emphasized that the viable tissues should be preserved during the emergency debridement, so as to facilitate the following reconstruction procedure.