Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. Methods From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients’ (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distalone third of nai bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm. Results All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swell ing. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the heal ing time was 4-5 weeks. All finger nails were smooth and flat without pain. Conclusion When there was no indication of replantation in thumb fingertip amputation, establ ishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graf
Fiftyone thumbs with complete or partial loss of the distal segment in 50 patients has been reconstructed with transplantation of great or second toe by microsurgical technique from 1985 to 1993. All cases were survived and regained favourable functions. Ninteen cases had been followup after operation, with an average of 51 months. In the group Ⅱ° of thumb loss, the overall functional impairment inproved from 11% to 1.7%, and in the remaining cases, from 5% to 0%. Sensation examination found S+3 in 42%, S4 in 37% and the two point discrimination between 4mm to 10mm. The merits of reconstruction of the distal thumb segment was stated and emphasized. The choice of operative procedures, the advantagesof emergency reconstruction, the selection emphasized of anastomosis site of blood vessels and the complications and sequelae of the donor foot were discussed in detaill.
Objective To investigate the therapeutic effect of minimally invasive small incision surgery under local anesthesia for pediatric stenosing tenovaginitis of thumb. Methods A retrospective analysis was conducted on the medical records of children with stenosing tenovaginitis of thumb who received small incision tendinolysis under local anesthesia at West China Hospital of Sichuan University between January 2013 and August 2022, to evaluate and analyze the safety and effectiveness of the surgery. Results A total of 949 pediatric patients were included, with an average age of (3.23±1.92) years. The average duration of surgery was (7.0±2.5) minutes, and the average follow-up time was (3.91±5.32) months. All patients did not need to fast for solids and liquids before surgery, and were immediately discharged from the hospital after outpatient surgery. The family members of the patients were highly satisfied with the treatment process and postoperative recovery. All patients had no nerve or vascular damage, and the wound margin skin showed linear healing with mild scars that fused with palm prints. There were 825 cases (86.93%) of children with thumb function fully restored to normal, 113 cases (11.91%) with limited maximum dorsiflexion function of the thumb, and 11 cases (1.16%) with recurrent stiffness of the thumb metacarpophalangeal joint. Conclusion Small incision tendinolysis under local anesthesia is a safe and effective treatment for pediatric stenosing tenovaginitis of thumb, with high satisfaction among the patients’ family members.
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.
Objective To investigate the effectiveness of transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion. Methods Between January 2007 and May 2015, 23 patients with thumb nerve avulsion were treated by transferring the ulnaris proper digital nerve of index finger and its dorsal branch. There were 17 males and 6 females with an average age of 32 years (range, 16-63 years). The injuries were caused by machine twist in 10 cases, electric saw in 8 cases, and sharp article prick in 5 cases. And thumb rotational avulsion amputation happened in 8 cases, thumb incomplete amputation in 2 cases, laceration of thumb palmaris with the thumb nerve avulsion of both sides in 13 caese (7 cases with tendon rupture). The time from injury to operation was 1.0-3.5 hours (mean, 2.2 hours). Results All incisions healed by first intention. Ten cases of thumb reimplantation were successful. All the patients were followed up for 5 months to 2 years and 8 months, with an average of 1 year and 4 months. Two-point discrimination was 3-9 mm (mean, 6.8 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the sensory of the thumb was rated as S4 in 18 cases and \begin{document}${{\rm{S}}_{\scriptsize{3^ + }}}$\end{document} in 5 cases; the sensory at donor sites recovered to S3. Conclusion Transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion is a simple and effective method to restore sensory function of the thumb pulp.