PURPOSE: Transverse type or volar oblique type of defect of thumb tip can be covered by Moberg flap or second toe pulp free flap. We compared these two methods in functional result, patients' satisfaction, and sensation, etc. to find a better way to cover the defect of the thumb tip. METHODS: From 2003 to 2006, we chose the patients randomly with preoperative pictures. The patients had the defect of the thumb tip which is either transverse or volar oblique type. The 6 patients were treated with Moberg flap and other 6 patients were treated with second toe pulp free flap. We have analyzed the results by 2 point discrimination, side pinching power test, pulp to pulp pinching power test, pain scales (visual analogue scale), satisfaction scales of the patients (functional and aesthetic), the degree of the range of motion, etc. RESULTS: All flaps survived without any complications. In the cases of Moberg flaps, the value of static 2 point discrimination test was 5.6mm, and the value of moving 2 point discrimination test was 4.8mm. In the cases of second toe pulp free flaps, the values were 9.6mm and 9.3mm. In the cases of Moberg flaps, the value of the Side pinch power test was 6.6kg, 4.4kg. In the case of second toe pulp free flaps, the values were 4.8kg and 2.5kg. The value of aesthetic satisfaction scale of the patients in Moberg flaps was 5.6, the value of functional satisfaction scale of the patients was 3.6. In cases of second toe pulp free flaps, the values were 5.6 and 3.6. The active range of motion of Interphalangeal joint in the cases of Moberg flaps was 46.6 degree, and the active range of motion of metacarpophalangeal joint was 55 degree, in the cases of second toe pulp free flaps, the values were 36.6 degree and 59 degree. CONCLUSION: As a result, when the defect of the thumb tip is transverse or volar oblique type, we suggest that the operators choose Moberg flap to cover the defect of the thumb tip.
Amputation ; Discrimination (Psychology) ; Free Tissue Flaps ; Humans ; Joints ; Metacarpophalangeal Joint ; Range of Motion, Articular ; Sensation ; Thumb ; Toes ; Weights and Measures

Full skin auto-grafts are required for reconstruction of skin burns and trauma scars. However, currently available clinical approaches such as sheet skin graft, mesh skin grafts, artificial skin graft, and in vivo skin expansion have limitations due to their potential danger for secondary damage and scar formation at the donor site, and discomfort during skin expansion. We developed an advanced bioreactor system and evaluated its function in skin expansion using porcine full skin. The reactor was designed as a pneumatic cylinder type, was programmed to adjust the pressure and the operating time. The system was composed of culture chamber unit, environmental control unit, and monitoring unit. Skins were expanded at 200 kPa pneumatic force and the expanded skins were analyzed by immunohistochemistry and histology. Furthermore we carried out auto-grafting experiment of the expanded skins in vivo using Yucatan pigs and skins were harvested and histologically analyzed after 8 weeks. The results showed that the bioreactor expanded skins to 160% in 4 hours. Histological analysis of the expanded skins revealed that epidermal cells and dermal fibroblasts were viable and remained integrity. The results of auto-grafting experiment indicated that fibrosis and scars were not detected in the grafted skins. This study demonstrates that the newly developed skin bioreactor enabled to obtain large sized full skin rapidly and successful grating.
Bioreactors* ; Burns ; Cicatrix ; Fibroblasts ; Fibrosis ; Humans ; Immunohistochemistry ; Skin* ; Skin, Artificial ; Swine ; Tissue Donors ; Transplants