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Ahangar P, Akbaribazm M, Rahimi M, Pirmohamadi H. A case series study in new restorative surgery in thumb amputation: The Adiposofaciocutaneous flap technique for distal thumb amputation replantation. Trauma Case Rep 2024; 52:101052. [PMID: 38948102 PMCID: PMC11214319 DOI: 10.1016/j.tcr.2024.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Thumb distal amputation refers to the loss of a portion of the thumb at or near the tip, which can be caused by various injuries such as crush injuries, lacerations, or avulsions. Several surgical methods can be used to repair thumb distal amputations, including composite graft, flap reconstruction, replantation, and amputation revision. In this case report, we describe a successful surgical procedure performed on three healthy men (19, 26, and 44 years old) who suffered a sharp amputation of their left and right hands thumb. In one case initial fixation of the amputated part was performed by a general orthopedic surgeon as a composite graft, two other cases were referred us without any procedure. The procedure involved irrigation and minimal debridement and deepithelializing the amputated part and fixation it with one or two 1.5 mm steinman pins and repairing the nail bed with7/0 absorbable sutures. An adiposofaciocutaneous flap from the index finger was used to cover the pulp of the thumb and the nail bed, while a full-thickness grafts from the same wrist in one case and medial part of ipsilateral arm in others were used to repair the defect on the dorsal side of the index finger. The wound was dressed, and the sutures were removed after two weeks. The base of the flap was detached from the index finger after three weeks, and the kwires were removed after six weeks. The flap and graft were successfully taken, except for a small part of the tip of the thumb. Two years after the operation, in two patients and 3 months in whom was operated recently, all the patient's thumbs had a reasonable shape and length with minimal nail deformity. The use of an index finger based adiposofaciocutaneous flap and full-thickness graft in these cases allowed for successful reconstruction of the thumb and, improving both function and appearance.
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Affiliation(s)
| | - Mohsen Akbaribazm
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy 65371-17636, Iran
| | - Mohsen Rahimi
- Department of Parasitology and Mycology, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hosein Pirmohamadi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Zhou X, Sun D, Liu F, Li WJ, Gu C, Zhang LL. A mini hallux neurovascular osteo-onychocutaneous free flap for refined reconstruction of distal defects in thumbs and fingers. J Plast Surg Hand Surg 2023; 57:415-421. [PMID: 36495035 DOI: 10.1080/2000656x.2022.2147695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Distal injury in thumbs and fingers is common in emergency. Although multiple surgical techniques have been introduced for repair purpose, it is still challenging for restoring both good function and cosmetic appearance. The present study reports our experiences on how to reconstruct amputated fingertips in thumbs and fingers using a mini hallux neurovascular osteo-onychocutaneous free flap with favorable outcomes in 15 patients (average age, 27.27 ± 5.43 years old). Follow-up period was 19.47 ± 10.18 months (range, 6-48 months). Digital function was improved indicated by the static two-point discrimination (2-PD) and key-pinch, which were 8.40 ± 1.64 mm (range, 6-12 mm) and 85.37 ± 3.03% (range, 80.2-90.6%) of that of the intact contralateral thumbs and fingers, respectively, after surgery. As to aesthetic outcomes, all reconstructed digits were self-graded as good by patients. 73.3% of the donor halluces were self-graded as good and four halluces (26.7%) were graded as fair. In conclusion, the mini hallux neurovascular osteo-onychocutaneous flap may be used for refined reconstruction of type I amputated injury in thumbs and fingers achieving both satisfactory functional and aesthetic outcomes.
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Affiliation(s)
- Xianyu Zhou
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Di Sun
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Fei Liu
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wen Jun Li
- Department of Hand Surgery, Shanghai Zhongye Hospital, Shanghai, People's Republic of China
| | - Chuan Gu
- Department of Hand Surgery, Shanghai Zhongye Hospital, Shanghai, People's Republic of China
| | - Ling Ling Zhang
- Department of Hand Surgery, Shanghai Zhongye Hospital, Shanghai, People's Republic of China
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The Efficacy of Subdermal Pocket Procedure in Fingertip Replantation With Composite Graft. Ann Plast Surg 2022; 90:S89-S94. [PMID: 36729843 DOI: 10.1097/sap.0000000000003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Microsurgical replantation of fingertip amputation is sometimes difficult because of a lack of available vessels. Composite grafting is an alternative method for nonvascularized replantation, but it has a limited success rate. The subdermal pocket (SDP) procedure is proposed to increase the survival of composite graft. AIM AND OBJECTIVES We aimed to compare the success rate of the composite graft used in fingertip replantation with or without application of the SDP procedure. PATIENTS AND METHODS From 2000 to 2020, 29 fingertip amputations (28 complete amputations, 1 near-complete amputation) from 28 patients were included. Five of the fingertip amputations were classified as Ishikawa zone Ib and 24 as Ishikawa zone II. Seventeen fingers underwent replantation with composite graft plus SDP procedure, whereas the remaining 12 fingers received replantation with composite graft only. RESULTS The overall success rate was 70.59% (12 of 17) in the SDP group and 41.67% (5 of 12) in the composite graft-only group (P = 0.119; odds ratio, 3.36). In the subgroup of Ishikawa zone II fingertip amputations, the success rate was 66.67% (10 of 15) in the SDP group and 22.22% (2 of 9) in the composite graft-only group (P = 0.035; odds ratio, 7.0). CONCLUSIONS The SDP procedure could increase the success rate of fingertip replantation with composite graft, especially for Ishikawa zone II amputations.
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Eo S, Doh G, Lim S, Hong KY. Analysis of the risk factors that determine composite graft survival for fingertip amputation. J Hand Surg Eur Vol 2018; 43:1030-1035. [PMID: 30176751 DOI: 10.1177/1753193418795820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The composite graft is the only surgical method that is able to maintain digital length and provide soft tissue coverage without donor site morbidities in microsurgically non-replantable fingertip amputations. This study aimed to explore the risk factors that determine the survival of composite grafts. Clinical characteristics associated with graft survival were retrospectively analysed by a comparison between the graft survival and failure groups. Of 94 patients who underwent a composite graft for fingertip amputation, the graft survived in 84 (89%). Surviving grafts showed reperfusion within 1 week. Multivariate analysis revealed that graft failure was independently associated with a crushing injury. Based on the risk factors from the comparison analyses and a review of previously published studies, a cutting injury, grafting the injured finger within 5 hours of injury, and being a non-smoker are associated with good results. In these circumstances, excellent outcomes with a high success rate can be achieved by composite graft in most adult patients as an alternative treatment to microsurgical replantation. Level of evidence: IV.
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Affiliation(s)
- SuRak Eo
- Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - GyeongHyeon Doh
- Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - SooA Lim
- Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
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Lai HT, Wu SH, Lai YW, Hsieh TY, Lee SS, David Wang HM, Chang KP, Lin SD, Lai CS, Huang SH. Composite grafting with pulp adipofascial advancement flaps for treating non-replantable fingertip amputations. Microsurgery 2016; 36:651-657. [DOI: 10.1002/micr.30051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/24/2016] [Accepted: 03/17/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Hsin-Ti Lai
- Division of Plastic Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
| | - Sheng-Hua Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Anesthesia; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
| | - Ya-Wei Lai
- Division of Plastic Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
| | - Tung-Ying Hsieh
- Division of Plastic Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
| | - Su-Shin Lee
- Division of Plastic Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
- Center for Stem Cell Research, Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Hui-Min David Wang
- Center for Stem Cell Research, Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Fragrance and Cosmetic Science; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Kao-Ping Chang
- Division of Plastic Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Sin-Daw Lin
- Division of Plastic Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Chung-Sheng Lai
- Division of Plastic Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung Medical University; Kaohsiung Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University; Kaohsiung Taiwan
- Center for Stem Cell Research, Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University; Kaohsiung Taiwan
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Fernandez MS. Macrosurgery for fingertip amputations. BMC Proc 2015. [PMCID: PMC4445494 DOI: 10.1186/1753-6561-9-s3-a58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Han HH, Choi YS, Kim IB, Kim SH, Jun YJ. A perforator from the ulnar artery and cutaneous nerve of the hypothenar area: An anatomical study for clinical application. Microsurgery 2015; 37:49-56. [DOI: 10.1002/micr.22463] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/28/2015] [Accepted: 07/20/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Hyun Ho Han
- Department of Plastic and Reconstructive Surgery, College of Medicine; the Catholic University of Korea; Seoul Korea
| | - Yong Seong Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine; the Catholic University of Korea; Seoul Korea
| | - In Beom Kim
- Department of Anatomy; Catholic Institute for Applied Anatomy, College of Medicine, the Catholic University of Korea; Seoul Korea
| | - Sang Hyun Kim
- Department of Anatomy; Catholic Institute for Applied Anatomy, College of Medicine, the Catholic University of Korea; Seoul Korea
| | - Young-Joon Jun
- Department of Plastic and Reconstructive Surgery, College of Medicine; the Catholic University of Korea; Seoul Korea
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Tan VH, Murugan A, Foo TL, Puhaindran ME. Cross-finger dermal pocketing to augment venous outflow for distal fingertip replantation. Tech Hand Up Extrem Surg 2014; 18:131-134. [PMID: 24854151 DOI: 10.1097/bth.0000000000000051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Venous anastomosis in distal fingertip replantations is not always possible, and venous congestion is recognized as a potential cause of failure. Methods previously described to address this problem include amputate deepithelization and dermal pocketing postarterial anastomosis to augment venous outflow. However, attachment of the digit to the palm or abdomen resulted in finger stiffness. We describe a modification of the previous methods by utilizing dermal flaps raised from the adjacent digit in the form of a cross-finger flap. The key differences are the partial deepithelization of the replanted fingertip and subsequent replacement of the dermal flap to the donor digit to minimize donor site morbidity. During the period where the 2 digits are attached, interphalangeal joint mobilization is permitted to maintain joint mobility.
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Affiliation(s)
- Valerie H Tan
- *Yong Loo Lin School of Medicine, National University of Singapore †Department of Orthopedics, Tan Tok Seng Hospital ‡Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
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Imaizumi A, Ishida K, Arashiro K, Nishizeki O. Validity of exploration for suitable vessels for replantation in the distal fingertip amputation in early childhood: Replantation or composite graft. J Plast Surg Hand Surg 2013; 47:258-62. [DOI: 10.3109/2000656x.2012.755128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Abstract
In the last 40 years, childhood hand and wrist injuries have become progressively more common as children have become heavier and more active in high impact sports. The majority of children with such injuries do well, but treatment is not always straightforward. Distal radius fractures, scaphoid fractures, metacarpal and phalangeal fractures, nailbed injuries, and amputations are among the pediatric hand and wrist injuries most often seen by orthopedists. These are all discussed, with a focus on the most recent literature and areas of evolving controversy.
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Affiliation(s)
- Ariel A. Williams
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287 USA
| | - Heather V. Lochner
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287 USA
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Treatment of fingertip amputation in adults by palmar pocketing of the amputated part. Arch Plast Surg 2012; 39:404-10. [PMID: 22872846 PMCID: PMC3408288 DOI: 10.5999/aps.2012.39.4.404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/06/2012] [Accepted: 05/07/2012] [Indexed: 12/04/2022] Open
Abstract
Background First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. Methods Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm. Results Of a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results. Conclusions A composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.
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Adani R, Marcoccio I, Tarallo L. TREATMENT OF FINGERTIPS AMPUTATION USING THE HIRASE TECHNIQUE. ACTA ACUST UNITED AC 2011; 8:257-64. [PMID: 15002108 DOI: 10.1142/s0218810403001777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2002] [Accepted: 10/23/2003] [Indexed: 11/18/2022]
Abstract
The management of very distal finger amputations when the amputated part is saved is still difficult and controversial. Both re-attachment of the amputated portion as a composite graft and microvascular anastomosis can fail in this distal location. Replantation is, in fact, associated with certain problems, such as technical difficulty, risk of failure because of the poor venous drainage, and costs. With the exception of children, amputations at the level of the lunula poorly survive direct re-attachment. Hirase has described a new replantation model without vascular anastomosis and used ice water and aluminium foil to enhance survival of the composite graft. Cooling the entire recipient site retards cellular degeneration in the graft until neovascularisation occurs. The present authors applied this method to seven cases in which a digit had been amputated between the tip and the lunula. In four cases the method proved to be completely successful, whereas in two an area of tip necrosis was observed. The Hirase method has proven to be a simple and reliable surgical technique for fingertip re-attachment.
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Affiliation(s)
- R Adani
- Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Largo del Pozzo n. 71, 41100 Modena, Italy.
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Traitement par greffe composée des amputations distales des doigts : à propos d’une étude clinique de neuf cas. ANN CHIR PLAST ESTH 2010; 55:313-7. [DOI: 10.1016/j.anplas.2009.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 11/07/2009] [Indexed: 11/22/2022]
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Puhaindran ME, Paavilainen P, Tan DM, Peng YP, Lim AY. Dermal pocketing following distal finger replantation. J Plast Reconstr Aesthet Surg 2010; 63:1318-22. [DOI: 10.1016/j.bjps.2009.06.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 06/25/2009] [Accepted: 06/25/2009] [Indexed: 11/15/2022]
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Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg 2008; 122:105e-117e. [PMID: 18766028 DOI: 10.1097/prs.0b013e3181823be0] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the anatomy of the fingertip. 2. Describe the methods of evaluating fingertip injuries. 3. Discuss reconstructive options for various tip injuries. SUMMARY The fingertip is the most commonly injured part of the hand, and therefore fingertip injuries are among the most frequent injuries that plastic surgeons are asked to treat. Although microsurgical techniques have enabled replantation of even very distal tip amputations, it is relatively uncommon that a distal tip injury will be appropriate for replantation. In the event that replantation is not pursued, options for distal tip soft-tissue reconstruction must be considered. This review presents a straightforward method for evaluating fingertip injuries and provides an algorithm for fingertip reconstruction.
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Uysal A, Kankaya Y, Ulusoy MG, Sungur N, Karalezli N, Kayran O, Koçer U. An Alternative Technique for Microsurgically Unreplantable Fingertip Amputations. Ann Plast Surg 2006; 57:545-51. [PMID: 17060737 DOI: 10.1097/01.sap.0000226944.08332.41] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reattachment of the amputated fingertips as composite grafts has been performed for distal levels in children, with high rates of good outcome, but the majority of the reports emphasized that this procedure had success rates only up to 50% in adults. Several techniques to enhance composite graft take in adults have been defined. In this study, a technique to enhance nonmicrosurgical replantation of amputated fingertips as composite grafts is presented.Twenty-three patients were treated with this technique, 20 of which were adults. An area of skin on the amputation margin of the stump was deepithelized, and the amputated part was defatted to reattach the piece as a cap composite graft and to increase the contact area. The patients were evaluated after the operations regarding functional and esthetic outcome. Success rates of 86.95% in total and 85% in adults were achieved, with acceptable sensibility (with a mean value of 7.26 mm for the 2-point discrimination), minimal shortening (a mean value of 6.80 mm), and satisfactory esthetic outcome using this technique.
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Affiliation(s)
- Afşin Uysal
- Ankara Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Ankara, Türkiye.
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Muneuchi G, Tamai M, Igawa K, Kurokawa M, Igawa HH. The PNB Classification for Treatment of Fingertip Injuries. Ann Plast Surg 2005; 54:604-9. [PMID: 15900144 DOI: 10.1097/01.sap.0000158066.47194.9a] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The PNB classification, which was advocated by Evans and Bernadis, separates the injuries into their effects on 3 components of the fingertip: pulp, nail, and bone. Because each component is subdivided into 7 or 8 items, this can describe fingertip injuries more precisely. Between 1997 and 2003, we treated 381 fingertip injuries (279 males, 102 females; average age, 41.2 years) in our facilities. A 3-digit number was provided for each of the 381 cases in accordance with the PNB classification. We extracted patients in whom amputated tissues did not exist, and predicted the boundary between conservative treatment and surgical treatment by individually comparing the curative results of the same type of injuries. In conclusion, PNB 355-366 and PNB 455-466 were most suitable for surgical treatment, and the boundaries between surgical treatment and conservative treatment were PNB 386 and 666 and 700. The results, which are the criteria for surgical treatment, are summarized as follows; 1) More than two thirds of the distal phalanx remains. 2)The nail bed defect ranges from one third to half. If the defect is more or less than the criteria, the surgical treatment is less significant. Recognition of the boundary and prevention from unnecessary surgical treatment leads to minimum invasive surgery for fingertip injuries.
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Affiliation(s)
- Gan Muneuchi
- Department of Plastic and Reconstructive Surgery, Kagawa University, Kagawa, Japan.
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Sawabe K, Suzuki S, Miyata A, Kitayama T, Ishikawa K. Application of the Palmar Pocket Method for Total Nail Reconstruction Without Vascular Anastomoses. Ann Plast Surg 2005; 54:673-5. [PMID: 15900160 DOI: 10.1097/01.sap.0000164731.99795.fe] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of a nail defect, which was reconstructed by free composite nail combined with the palmar pocket method without vascular anastomoses. A 40-year-old man lost his nail of the right middle finger by trauma 1 year ago. A total nail composite graft, composed of germinal and sterile matrices, and proximal nail fold, from which the nail plate was removed, was harvested from the ipsilateral first toe and was grafted on the right middle fingertip. The grafted nail was inserted into the palmar subcutaneous pocket. Fourteen days after the first operation, the grafted part was removed from the pocket, and active bleeding was noted on the sterile matrix. Seven months after the second surgery, the nail had grown and had an almost normal appearance. There was no conspicuous scar at either the recipient or the donor site.
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Affiliation(s)
- Kazuma Sawabe
- Department of Plastic and Reconstructive Surgery, Kyoto University, Kyoto, Japan.
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Muneuchi G, Kurokawa M, Igawa K, Hamamoto Y, Igawa HH. Nonmicrosurgical replantation using a subcutaneous pocket for salvage of the amputated fingertip. J Hand Surg Am 2005; 30:562-5. [PMID: 15925168 DOI: 10.1016/j.jhsa.2004.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Revised: 10/20/2004] [Accepted: 10/22/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE The pocket principle suggested by Brent in 1979 is an alternative method for use when microsurgical replantation is not feasible. The application and the amputation level for which the method is available, however, have not been well examined. METHODS Between 1999 and 2003 we treated 6 patients (7 fingers) by nonmicrosurgical replantation using a subcutaneous pocket (the Brent technique). All patients had sustained complete fingertip amputations across or proximal to the lunula in digits other than the thumb. In every case the amputation was a crush or avulsion-type injury and microsurgical replantation was not feasible; however, cosmetic symmetry was desired strongly by the patient. RESULTS Of the 7 fingers only one survived completely but became atrophic after 4 months. One finger developed necrosis involving less than half of the replant but a hooked nail deformity developed. Two fingers developed partial necrosis involving more than half of the replant but both fingers were missing the fingernail and the cosmetic results were not acceptable. Three fingers developed total necrosis. In addition a slight flexion contracture not improved with therapy in the digits was noted in 4 patients. CONCLUSIONS The Brent technique should be performed scrupulously for fingertip amputation across or proximal to the lunula because of the poor survival rate and the possibility of contracture in the digits or other proximal joints.
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Affiliation(s)
- Gan Muneuchi
- Department of Plastic and Reconstructive Surgery, Kagawa University, Ikenobe, Miki, Kita, Kagawa, Japan.
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Abstract
Restoration of finger length and function are the goals of replantation after fingertip amputation. Methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. To increase the survival rates for composite grafts, the subcutaneous pocket procedure has been used as a salvage procedure. The subdermal pocket procedure, which is a modification of the subcutaneous pocket procedure, was used for replantation of 17 fingertips in 16 consecutive patients. Eight fingertips experienced guillotine injuries and the other nine fingertips experienced crush injuries. Revascularization of one digital artery without available venous outflow was performed for six fingers, and composite graft techniques were used for the other 11 fingers. The success rate was 16 of 17 cases. The difference in success rates for guillotine versus crush injuries was statistically significant. Comparison of patients with arterial anastomoses and patients without arterial anastomoses also indicated a statistically significant difference. Thirteen fingertips survived completely. One finger, demonstrating complete loss and early termination of the pocketing procedure, was amputated on the eighth postoperative day. Two fingers were partially lost because of severe crushing injuries. One finger demonstrated partial loss of more than one quarter of the fingertip, which required secondary revision, because the patient was a heavy smoker. The pocketing period was 8 +/- 1 days (mean +/- SD, n = 6) for the fingers revascularized with one digital arterial anastomosis and 13.3 +/- 1.9 days (n = 10) for the fingers successfully replanted with composite graft techniques. The mean active range of motion of the interphalangeal joint of the three thumbs was 65 +/- 5 degrees, and that of the distal interphalangeal joint of the other 11 fingers was 51 +/- 11 degrees. The static two-point discrimination result was 6.4 +/- 1.0 mm (n = 14) after an average of 11 +/- 5 months of follow-up monitoring. Compared with other methods, the subdermal pocket procedure has the advantages of exact subdermal/subdermal contact, a shorter pocketing period, and more feasible observation. The method can offer an alternative salvage procedure for fingertip amputations with no suitable vessels available for microsurgical replantation.
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Affiliation(s)
- Tsan-Shiun Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung Hsien, Taiwan.
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Nakagawa T, Kato A. Fingertip reconstruction using a duplicated thumb by means of the palmar pocket method in a child. Plast Reconstr Surg 2003; 112:1730-2. [PMID: 14578810 DOI: 10.1097/01.prs.0000084561.94439.1d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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The Dorsal Reverse Adipofascial Flap for Fingertip Reconstruction; Dimitrios H. Laoulakos, M.D., Constantinos H. Tsetsonis, M.D., Aggelos A. Michail, M.D., Olga S. Kaxira, M.D., and Phillipos H. Papatheodorakis, M.D. Plast Reconstr Surg 2003. [DOI: 10.1097/01.prs.0000066166.75022.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arata J, Ishikawa K, Soeda H, Kitayama T. Replantation of multi-level fingertip amputation using the pocket principle (palmar pocket method). BRITISH JOURNAL OF PLASTIC SURGERY 2003; 56:504-8. [PMID: 12890466 DOI: 10.1016/s0007-1226(03)00196-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Two cases of multi-level fingertip amputation are presented. In each case, replantation was achieved in a two-stage procedure, involving reattachment, de-epithelialisation and insertion into a palmar pocket in stage 1, followed by removal from the palmar pocket 16 days later. The cases are described and the technique is discussed.
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Affiliation(s)
- J Arata
- Department of Plastic and Reconstructive Surgery, Kyowa Hospital, 30 Kawakubo-cho Daigo, Fushimiku, Kyoto 6011378, Japan.
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Sakai S. Reconstruction of an amputated fingertip by a prefabricated free volar forearm flap. BRITISH JOURNAL OF PLASTIC SURGERY 2002; 55:523-6. [PMID: 12479432 DOI: 10.1054/bjps.2002.3916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An amputated fingertip was banked temporarily under the skin of the volar wrist. This prefabricated fingertip was transferred back to the finger 2 months later, together with a free flap from the volar wrist based on the superficial palmar branch of the radial artery. The fingertip pulp showed a little pale pigmentation, but maintained its length well. The dorsal tip of the finger looked normal. This two-stage procedure made it possible to salvage the amputated bone and nail.
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Affiliation(s)
- S Sakai
- Department of Plastic and Reconstructive Surgery, Tottori Prefectural Central Hospital, Tottori City, Tottori, Japan
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