Reconstruction of distal thumb injuries still remains a challenge for hand surgeons. Surgical treatment includes the use of local, regional, and free flaps. The purpose of this report is to present the results of the use of a sensitive reverse flow first dorsal metacarpal artery (FDMA) flap. The skin flap was designed on the radial side of the proximal phalanx of the index finger based on the ulnar and radial branch of the FDMA and a sensory branch of the superficial radial nerve. This neurovascular flap was used in five patients to cover distal soft-tissue thumb defects. All flaps achieved primary healing except for one patient in whom superficial partial necrosis of the flap occurred, and the defect healed by second intention. All patients maintained the thumb original length and were able to return to their previous daily activities. The reverse flow FDMA flap is a reliable option to cover immediate and delayed defects of distal thumb, offering acceptable functional and cosmetic outcomes in respect to sensibility, durability, and skin-match.
The Essex-Lopresti lesion, or radioulnar longitudinal dissociation, results from an axial load to the forearm with lesion to the radial head, interosseous membrane and distal radioulnar joint. The lesion is rarely diagnosed early, therefore treatment is often subacute or chronic. In these cases, procedures such as radial head replacement, ulnar shortening and/or wafer procedures should be combined with reconstruction of the interosseous membrane central band to restore longitudinal stability of the forearm. In the technique described, we use a folded fascia lata allograft fixed with specific device throughout transulnar and transradial tunnels passed through dorsal soft tissue access. The graft tension is progressively addressed with the help of fixation device. It seems an easily surgical technique without donor site morbidity.
Total dislocation of the capitate is an extremely rare event. We report on one such unusual case. The complete expulsion of the capitate from its physiological position is difficult to diagnose. Standard parameters of the antero-posterior and lateral radiological do not head to a definite diagnosis. In our patient, the only real diagnostic tool was the clinical assessment and the Gilula arches alteration to the standard antero-posterior projection. In the period following trauma, the patient reported a very high level of pain in the wrist. Since this could not be correlated to the lesions that had been diagnosed, we hypothesized the presence of any carpal bones damage. A definite diagnosis was obtained at CT scan, which also revealed the absence of any fractures.
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