Hallux-to-hand transfer

Irrigation Pressure and Vessel Injury During Microsurgery: A Qualitative Study

“…Other authors report vascular injury due to the type of irrigating solutions and temperature. [2][3][4]7,9,11 Our study demonstrates that irrigating pressure correlates directly with the degree of endothelial damage. The irrigation stream causes two types of vessel damage: directed lash force and peel force.…”

“…[9][10][11] It is known that there are multiple complex factors which can induce microsurgical thrombosis. 2,3,9 However, in many cases of microsurgical failure, the actual etiology of circulatory crisis is not known. [15][16][17][18][19][20] Uncontrolled irrigation pressures, along with widespread and prolonged irrigation times, may induce injury and may be responsible for anastomotic failure in some of these cases.…”

“…These solutions help in visualization of the anastomotic site, clearing of the vessel lumen, and in the application of anticoagulant flush. [1][2][3][4] Vascular injury secondary to the composition and concentration of the irrigation solution has been investigated, yet physical damage caused by the pressure of irrigating flow has not been examined. [5][6][7][8] Gentle flow can be therapeutic, but when the same solution is propelled at an increased force, it may injure the vessel intima.…”

Management of the amputated thumb

“…Pollicization of the index finger restores an opposing digit at the expense of one finger and hand width, and results in a thumb of rather spindly appearance. Reconstruction of the thumb by toe transfer was first described by Cobbett in 1969 (4), but we use the modified technique described by O'Brien et al in 1975 (1).…”

Indications for Microvascular Upper Extremity Reconstruction

“…18). [23][24][25] A two-toe transfer may help restore prehensile hand function when all the fingers have been amputated leaving only a functional thumb (Fig. 19).…”