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.
ObjectiveTo summarize the clinical experience of the retrograde replantation for amputated toe. MethodsBetween January 2010 and August 2015, 11 cases of amputated toes (15 toes) were treated by the retrograde replantation. All patients were male, with a mean age of 31 years (range, 18-45 years). The causes included cutting injury in 6 cases (9 toes) and crush injury in 5 cases (6 toes). One case had amputated great toe and distal segment of the second toe combined with the third toe nail bed contusion; 1 case had amputated proximal great toe and middle segment of the second and third toes; 1 case had amputated proximal segment of great toe and middle segment of the second toe; 7 cases had amputated distal segment of the great toe; and 1 case had amputated middle segment of the fifth toe. The time from injury to hospital was 1-3 hours (mean, 2 hours). ResultsThirteen toes survived completely after operation. Toe necrosis occurred in 1 toe; partial dorsal skins necrosis and nail bed necrosis occurred in 1 toe, and was cure after repaired with dorsalis pedis island flap. The rate of success for replantation of amputated toes was 93.33% (14/15). X-ray examination showed fracture healing of all survival toes at 8-12 weeks after operation (mean, 10 weeks); internal fixation was removed. Eleven cases were followed up 3-12 months (mean, 7.5 months). The survival toes had good appearance and toenail. The two point discrimination was 9-12 mm (mean, 10 mm) at last follow-up. The patients could walk and run normally. ConclusionIt is an ideal surgical method to use retrograde replantation to treat amputated toe, with the advantages of simple operation and high survival rate.
Two hundred and twenty-two toes to hands free transfers have been performed in our clinic from January 1973 to May 1992 with a 100 percent successful results obtained. The authors developed the extended toe free transfer technique,and this technique was used in 40 cases.Six types of extended toe transfer can be designed to carry out complicated thumb or other finger reconstructions.Keys to successful toe-to-hand transfers are as followings: Evaluation of a three-points and one line pulsation on the donor foot can be used to localize the course of the first dorsal metatarsal artery . The first dorsal metaltarsal artery is best dissected and exposed in the retrograde direction. The toe must obtain good blood perfusion before its transplantation and close postoperative monitor.
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.
ObjectiveTo review the research progress of interphalangeal arthrodesis in the treatment of interphalangeal joint deformity.MethodsThe literature about interphalangeal arthrodesis at home and abroad was extensively consulted, and the indications, fusion methods, fixation methods, complications, and so on were summarized and analysed.ResultsThe indications of interphalangeal arthrodesis are hammer toe, claw toe, and mallet toe. From the different forms of fusion surface, fusion methods include end-to-end, peg-in-hole, conical reamer type, and V-shape arthrodesis. There are three kinds of fixation methods: Kirschner wire fixation, stainless-steel wire suture fixation, and intramedullary fixation, and there are many kinds of intramedullary fixation. The complications of interphalangeal arthrodesis include vascular injury, fixation related complications, and postoperative complications.ConclusionInterphalangeal arthrodesis is a good way to correct some deformities of toes, but the incidence of various complications can not be ignored, and there is still a lack of clinical research on interphalangeal arthrodesis.
ObjectiveTo compare the effectiveness between toe transfer combined with an abdominal flap and bag-shaped abdominal flap for treatment of totally degloved hand. MethodsBetween January 2005 and January 2012,18 patients with totally degloved hand were treated by two kinds of techniques.Those patients were divided into 2 groups according to the technique.The bag-shaped abdominal flap was used in 8 cases (group A),and toe transfer with a dorsalis pedis skin flap combined with abdominal S-shaped tile-joint subdermal vascular network flaps was performed in 10 cases (group B).There was no significant difference in gender,age,injury cause,injury degree,and interval between injury and operation between 2 groups (P>0.05).The static two-point discrimination (s2PD),grip power of the reconstructed hand,time of returning to work,and active total range of motion (ROM) of the operated finger were compared between 2 groups to assess the effectiveness. ResultsAll flaps and skin grafts survived in 2 groups.One flap suffered vascular crisis at 2 days after operation and survived after surgical exploration in group B.All patients were followed up 12-24 months (mean,16 months).At last follow-up,group B showed a better recovery of s2PD of the thumb and ROM,and shorter time of returning to work than group A (P<0.05),but no significant difference was found in grip power of the reconstructed hand and s2PD of the other fingers between 2 groups (P>0.05). ConclusionThe technique of toe transfer combined with an abdominal flap is better than traditional bag-shaped abdominal flap with the advantages of easy dissection,less time of operation,and satisfactory functional recovery.