1/108. Fingertip reconstruction with flaps and nail bed grafts.We retrospectively reviewed the cases of 14 fingertips reconstructed with a combination of local or regional flaps and nail bed grafts, some of which were placed wholly or partially over a de-epithelialized flap. Most of the fingertips sustained a crushing injury and were reconstructed at the time of the injury. Soft tissue coverage was provided by palmar V-Y flaps in 6 cases, thenar flaps in 4, lateral V-Y flaps in 2, a Moberg flap in 1, and a cross-finger flap in 1. Split toenail bed grafts were used in 6 cases, full-thickness nail bed grafts from the amputated part in 6, and split nail bed grafts from the injured digit in 2. There was 1 partial graft loss and 1 partial flap loss. The remaining cases had completely successful grafts and good soft tissue healing. Subsequent nail growth and adherence were good in all but the 1 digit requiring secondary composite grafting.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/108. Dorsolateral toe flap as a neurovascular graft carrier in finger reconstruction.Simultaneous finger nerve and artery grafting, and soft-tissue coverage with a dorsolateral toe flap, including a plantar digital neurovascular bundle, were performed in a single patient. Although only fair sensory recovery was achieved, due to complicated wound healing, the toe flap as a neurovascular graft carrier can be a treatment of choice for reconstructing complex finger palmar defects.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
3/108. Free toe pulp transfer for digital reconstruction after high-pressure injection injury.We report two cases of high-pressure injection injuries to the fingertip in which free toe pulp flaps were used to resurface the palmar surface of the finger following extensive wound debridement. There was good return of sensibility and, because of the high durability of the donor skin, both patients regained good functional use of the injured digits and returned to heavy manual work. There was minimal associated morbidity of the donor sites. The free toe pulp flap represents an excellent alternative for resurfacing the digit with a large residual skin defect after high-pressure injection injury.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
4/108. Infections of the hand.In this paper the importance is stressed of the dangers associated with neglecting hand infections in Paua new guinea, where, for understandable reasons, there is a tendency for people to be slow in seeking treatment. The prevention of hand infections is emphasised, and the principles in regard to rest, antibiotic therapy, and surgical decompression are discussed. The more common types of hand infection are described, with particular reference to surgical anatomy and surgical drainage. Some of the more complicated infections such as middle palmar and thenar space infections, suppurative tenosynovitis, osteomyelitis and septic arthritis are of sufficient importance to warrant the attentions of the specialist surgeon when this is possible.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/108. The role of magnetic resonance imaging in late presentation of isolated injuries of the flexor digitorum profundus tendon in the finger.Four patients had magnetic resonance imaging (MRI) after a clinical diagnosis of a flexor digitorum profundus tendon rupture of the hand. The delay before presentation ranged from 1 to 5 weeks. Three patients had closed ruptures and one had a minor laceration which had healed. MRI showed proximal retraction of the profundus tendon to the palm in two patients and limited retraction in the other two. MRI provides important preoperative information for surgical decision-making and planning in patients who present late with closed flexor tendon injuries of the hand.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
6/108. Trapezo-metacarpal and metacarpo-phalangeal dislocation of the thumb associated with a carpo-metacarpal dislocation of the four fingers.The authors report a case of combined dorsal fracture-dislocations of all 4 fingers, palmar trapezo-metacarpal dislocation and metacarpophalangeal dislocation of the thumb following a motorbike accident. These exceptional lesions were treated as an emergency by reduction and pinning. With a follow-up of 13 years, the patient still worked as an electrician.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
7/108. Irreducible dorsal dislocation of the interphalangeal joint of the thumb due to the palmar plate. A case report.Dorsal dislocation of the thumb interphalangeal joint is rare. Only very few cases of irreducible dislocation has been reported at this joint. The authors report a case of compound irreducible dislocation due to the palmar plate interposition. The sesamoid, the flexor pollicis longus have been reported to block reduction of the dorsal dislocation of the thumb interphalangeal joint doctors on casualities should not insist if reduction is not easily obtained, the patient should then be guide towards a surgical team for surgical treatment.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
8/108. A reverse ulnar hypothenar flap for finger reconstruction.A reverse-flow island flap from the hypothenar eminence of the hand was applied in 11 patients to treat palmar skin defects, amputation injuries, or flexion contractures of the little finger. There were three female and eight male patients, and their ages at the time of surgery averaged 46 years. A 3 x 1.5 to 5 X 2 cm fasciocutaneous flap from the ulnar aspect of the hypothenar eminence, which was located over the abductor digiti minimi muscle, was designed and transferred in a retrograde fashion to cover the skin and soft-tissue defects of the little finger. The flap was based on the ulnar palmar digital artery of the little finger and in three patients was sensated by the dorsal branch of the ulnar nerve or by branches of the ulnar palmar digital nerve of the little finger. Follow-up periods averaged 42 months. The postoperative course was uneventful for all patients, and all of the flaps survived without complications. The donor site was closed primarily in all cases, and no patient complained of significant donor-site problems. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer, as indicated by 5 mm of moving two-point discrimination. A reverse island flap from the hypothenar eminence is easily elevated, contains durable fasciocutaneous structures, and has a good color and texture match to the finger pulp. This flap is a good alternative for reconstruction of palmar skin and soft-tissue defects of the little finger.- - - - - - - - - - ranking = 4keywords = palm (Clic here for more details about this article) |
9/108. The role of mini-fragment screw fixation in volar dislocations of the proximal interphalangeal joint.Palmar fracture-dislocations of the proximal interphalangeal (PIP) joint are uncommon injuries, which can be associated with long-term complications if sub-optimally treated. We report two cases of palmar fracture-dislocations of the PIP joint treated by open reduction and internal fixation using a single mini-fragment screw. The long term results of hand and finger function were excellent.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
10/108. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery.The dorsal digital and metacarpal island flaps have been described for use in a variety of clinical situations. On the basis of the authors' previous angiographic studies, these two skin flaps were planned on the dorsum of the proximal phalanx or intermetacarpal space based on the vascular anastomoses between the proximal dorsal cutaneous branches of the palmar digital artery and the dorsal digital branches of the dorsal metacarpal artery at the level of the proximal phalanx. The authors present a series of 13 patients using these flaps. To reconstruct the injured finger pulp, the reverse dorsal digital flap was used in 5 patients, and the reverse dorsal metacarpal flap was used in 8 patients. Most of the 13 patients sustained a work-related injury. Associated injuries of bone, joint, or tendon occurred in most patients. In all patients, the skin defect was located distal to the proximal interphalangeal joint. The skin paddle was taken from the dorsal aspect of the middle and ring fingers or the first, second, third, and fourth metacarpal area. All flaps survived completely. Two patients who had the dorsal branch of the sensitive radial nerve anastomosed to the digital nerve recovered 6-mm two-point discrimination in the reverse dorsal digital flap. The results of this anatomic study and the authors' clinical experience confirm the reliability of the dorsal digital and metacarpal island flaps.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
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