Microsurgical Digital Reconstruction by Vascularized Free Toe Pulp Transfer

Abstract

70S HAND 11(1S) 36.9 months (range, 25-49 months postinjury). The range of active motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ), and psychological sequelae including depression, anxiety, and postraumatic stress disorder (PTSD) were assessed. A correlation analysis among variables was also performed. Results: According to the Strickland criteria, the active motion of digits was excellent in 4 (15%), good in 6 (5%), fair in 9 (35%), and poor in 9 (45%) digits. The mean value of the total grip, pinch strength, and the SemmesWeinstein monofilament testing exceeded 80% of value of the healthy hand. However, the average value of static two point discrimination (s2PD) was less than half value of the healthy hand. The mean score for the DASH and MHQ was 6.9 and 58.9, respectively. The incidence of cold intolerance was 60%. Only 1 patient has showed the symptoms of depression and PTSD after 49 months postinjury as yet. Almost all patients returned to work and half of them did not change their former type of occupations. Conclusions: We concluded that the objective functional results of replanted digits did not affect the daily life and satisfaction of patients. Objective: To describe and present the results of surgical technique with the use of skin flap of second dorsal metacarpal artery retrograde flow to the treatment of patients with retraction of the first web space of the hand and, when necessary, apply longer flaps to cover the palm of the hand. Methods: Sixteen patients were operated with retraction of the first web space. In 6 patients, there was also scar retraction of the palm, in addition to the web space. Before surgery, the angle of opening of the first web space was measured, and the degree of shrinkage was divided into 3 groups: mild, moderate, and severe. Eleven cases were considered serious and 5 moderate. The authors describe in detail the surgical technique. Results: All 16 flaps had survival (100 cases). In 3 cases, there was partial suffering of about 10% of the distal area of the flap with transient ischemia and in 2 cases epidermolysis occurred, all with satisfying results. Retail dimensions ranged on average 10 cm in length and 2.2 cm in width, on average. In 87.5% of the cases there was total closure of the donor area. The opening of the first commissure ranged from 51° to 83° (average of 73.5°). Conclusion: The use of the cutaneous flap of the second metacarpal dorsal artery is reliable and it shows good results for the treatment of retractions of the first web space. It can be considered a good option for cases that present beyond the web space, retraction of the palm. Background: Restoring the aesthetic appearance and sensibility of the fingers, specially the fingertip, after traumatic amputation has an essential role in the functional recovery of the hand. Advances in microsurgery have allo...