Beauty and Function: The Use of Trimmed Great Toe in Thumb and Finger Reconstruction

Troisi, Luigi; Mazzocconi, Luca; Mastroiacovo, Alessandro; Vizcay, Macarena; Zanchetta, Francesco; Stucchi, Sara; Pajardi, G.

doi:10.1097/gox.0000000000004540

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…In traumatic hand surgery, it is accepted practice to attempt even technically complex replantations in the case of thumb injuries, even in conditions in which finger replantation is not favorable [ 1 ]. The loss of the thumb implies a hallux or second toe-free transplant to restore the opposition and grip function of the hand [ 6 ]. Although functionally satisfactory, these interventions involve a second surgery with the loss of a finger in a healthy area [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The loss of the thumb implies a hallux or second toe-free transplant to restore the opposition and grip function of the hand [ 6 ]. Although functionally satisfactory, these interventions involve a second surgery with the loss of a finger in a healthy area [ 6 ]. Another alternative to the sacrifice of a finger is a local flap, such as the posterior interosseous osteo-cutaneous flap, but with suboptimal results [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Evaluating Arterialized Vein in Thumb Replantation using Indocyanine Green Angiography: A Case Report

Costa,

Colonna,

Vindigni

et al. 2023

Am J Case Rep

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Patient: Male, 44-year-old Final Diagnosis: Amputated thumb Symptoms: Amputated thumb Clinical Procedure: — Specialty: Plastic Surgery • Surgery Objective: Unusual clinical course Background: The absence of valid vessels for the anastomosis constitutes a contraindication to replantation, but the need for arterial vessels in good condition has recently been questioned and some authors have proposed the arterialization of the veins with promising results. However, this method is not routine in replantation and it is unclear what conditions can establish venous congestion and loss of the replanted segment. Case Report: We detail a case where indocyanine green aids in evaluating arterialization of a vein during thumb replantation in a 40-year-old smoker following a crush injury. Multiple attempts to anastomose the princeps pollicis and its collateral vessel failed due to a thrombus formation, leaving the finger non-perfused despite urokinase treatment. To confirm the absence of reperfusion, we administered 0.3 mg/kg of indocyanine green through an upper limb peripheral vein. Observing no reperfusion, we located a suitable radial dorsal vein and performed an arteriovenous anastomosis at the proximal phalanx level. Indocyanine Green Angiography (IGA) revealed a slightly delayed reperfusion but a effective venous outflow. We did not consider it necessary to perform additional venous anastomoses other than the single dorsal radial venous anastomosis. Conclusions: This single case report shows the potential of indocyanine green as a valid aid to evaluate the perfusion of the replantation and also any early venous congestion, being able to modify the operative plan accordingly.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluating Arterialized Vein in Thumb Replantation using Indocyanine Green Angiography: A Case Report

Costa,

Colonna,

Vindigni

et al. 2023

Am J Case Rep

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“…43 Absolute contraindications to free tissue transfer include injured donor tissue, compromised donor or recipient vasculature or infections affecting either donor or recipient sites. 44…”

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confidence: 99%

Open Wound Reconstruction of the Thumb Tip: A Review of Current Literature and Case Reports

Cortes,

Datiashvili

2024

OAS

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The thumb is regarded as the most important digit of the hand, accounting for approximately 40% of the entire function of the hand, loss of a functional thumb leads to loss of key functions and patient autonomy. When the nature of the injury and the amputated part allow it, replantation is the standard of care. However, in cases of tip injury, where the amputated tissue is destroyed or otherwise rendered unusable, other reconstructive methods are used. It is imperative to maintain as much function and sensation as possible while restoring as much lost function and sensation as possible. This includes preservation of the interphalangeal (IP) joint, achieving good soft tissue coverage and restoring motor and sensory functions. With a variety of techniques described in the literature, thumb reconstruction proves to be a formidable task. Moreover, the technique selected must minimized complications associated with reconstruction such as hypersensitivity, contracture deformities, poor aesthetics, limited range of motion and insufficient coverage. We review and summarize the techniques of revision amputation, Moberg advancement flap, FDMA flaps, free tissue transfer from the great toe and non-operative management. We include case reports that highlight the benefits and limitations of some of these techniques.

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From Simple to Complex

Bacos,

Sasor

2024

Clinics in Plastic Surgery

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Beauty and Function: The Use of Trimmed Great Toe in Thumb and Finger Reconstruction

Cited by 3 publications

References 37 publications

Evaluating Arterialized Vein in Thumb Replantation using Indocyanine Green Angiography: A Case Report

Evaluating Arterialized Vein in Thumb Replantation using Indocyanine Green Angiography: A Case Report

Open Wound Reconstruction of the Thumb Tip: A Review of Current Literature and Case Reports

From Simple to Complex

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