Six volatic kite flaps were used to covering the missing lesions of thumb skin. The flaps were collected from dorsum of phalanx 1 and from hand-finger join 2. The flaps involved three feeding components: the dorsal finger 2 artery that separated from radial artery, vein, the nerve branch that separated from radial nerve. These flaps were used effectively for covering the missing lesion of inter-phalangeal joint 1-2. It is more difficult in covering the palm of phalanx 2 of finger 1 because the flap must be collected from far area, the blood supply is poor in distal tip and the flap is stretched. (There was one case in which this flap was used to cover the palm of phalanx 2 of finger 1 had necrosis in distal part of the flap).
Skin ; Thumb ; Surgical Flaps ; surgery

Humans ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Thumb ; abnormalities ; surgery

This case report describes the use of a Functional Thenar Eminence myocutaneous flap for reconstruction of volar defect of distal right thumb of a 25-year-old male who sustained a twisting injury while working. Part of bone and tendon were exposed and the tip of the distal phalanx was crushed, with bony defect.
Adult ; Humans ; Male ; Myocutaneous Flap ; Thumb ; injuries ; surgery

Metatarsal Bones/surgery* ; Thumb/abnormalities* ; Metacarpal Bones/surgery* ; Plastic Surgery Procedures

OBJECTIVES: To study the injury manners of Bennett fracture and Rolando fracture and explore its identification principle of the first metacarpal base fractures. METHODS: Totally 31 cases of Bennett fracture and Rolando fracture were collected. The injury manners of cases of 19 Bennett fractures and 12 Rolando fracture were classified, and various injury manners were analysed statistically. RESULTS: The injury manners of the cases of 19 Bennett fracture and 12 Rolando fracture were divided into three types, including the first metacarpus hit hard objects during a punching, the first metacarpus hit hard objects when making fists and fell, or the first metacarpus was punched by hard objects when making fists. CONCLUSIONS The injury mechanism of Bennett fracture and Rolando fracture is formed by a force on the first metacarpus when making fists, which transmits to the basilar part along the vertical axis of metacarpus. The inference of injury manners should be focused on the confirmation of entrusted matters.
Epiphyses ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Humans ; Joint Dislocations/surgery* ; Metacarpus/injuries* ; Thumb/injuries*

A traumatic carpometacarpal joint dislocation of the thumb accounts for less than 1% of all hand injuries. Optimal treatment strategies for this injury are still a subject of debate. In this article, we report a case of bilateral thumb carpometacarpal joint dislocations: a unique combination of injuries. We believe our case is the second report of bilateral carpometacarpal joint dislocation regarding the thumb in English literature. It was successfully treated with closed reduction and percutaneous K-wires fixation on one side, and an open reduction and reconstruction of the ligament on the other side.
Bone Wires ; Carpometacarpal Joints/*injuries/*surgery ; Dislocations/*surgery ; Hand Injuries/*surgery ; Humans ; Male ; Middle Aged ; Thumb/*injuries/*surgery

OBJECTIVETo discuss the therapeutic effect of thenar perforator flaps for the narrow cicatricial contracture at thumb and the first web.

METHODSFrom Aug. 2010 to Jan. 2012, 9 cases with narrow cicatricial contracture at thumb and the first web, were treated. The defect size after releasing the contracture ranged from 8 mm x 20 mm to 15 cm x 30 mm. The bilateral thenar perforator flaps beside the wound were designed which size was 10 mm x 25 mm to 15 mm x 35 mm. The wounds at donor sites were closed directly.

RESULTSAll the 9 flaps survived completely with primary healing. The patients were followed up for 6-18 months. The flaps had soft texture and good appearance. The shape of flaps and function of the fingers were satisfied after 6-18 months of follow-up. There was no scar contracture at incisions in thenar. The thumb motion was really normal. The abduction of first web was 70 degrees - 90 degrees degrees.

CONCLUSIONSThe thenar perforator flaps is one of the ideal methods for the treatment of narrow cicatricial contracture at thumb and the first web. The main artery is not sacrified.

Arteries ; Cicatrix ; surgery ; Contracture ; surgery ; Fingers ; Humans ; Perforator Flap ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Thumb ; surgery ; Wound Healing

OBJECTIVETo investigate an effective therapeutic method for the secondary deformity after the correction of the Wassel type IV thumb duplication.

METHODS9 cases of Wassel W-D Complex thumb deformities in children with postoperative secondary deformity, including 6 males and 3 female, were treated. The age ranged from 2.0 to 14 years old with an average of 5.3 years old. During the operation, the anatomical structure was dissected to observe the structure and alignment of the flexor tendon as well as anatomical structure of the joint. In the meantime, the flexor pollicis longus tendon was shifted, A2 pulley was reconstructed, joint capsule was released and contracted, the end point of thenar was shifted. Kirschner wires fixation were used for about 4-5 weeks, the brace fixation for about 3 months.

RESULTSAll the patients had radial side skin contracture of the interphalangeal joint, radial deviation of the thumb tip, radial side contracture and ulnar relaxation of the joint capsule. Flexor hallucis longus tendon was located in front of the radial side of the proximal phalanx, with no wrapped sheath or A2 pulley. Flexor hallucis longus tendon was attached to the thumb tip substrate, of which 1/3 was located in the center and 2/3 in the radial side. The thumb tip rotated about 10 degrees-15 degrees to the radial side. The patients were followed up for 6-38 months, with an average of 24 months. We adopted Tada standard to evaluate the follow-up results as excellent in 7 cases, good in 1 case, poor in 1 case.

CONCLUSIONSSoft tissue reconstruction for the secondary deformity after the correction of the Wassel type IV-D thumb duplication is an effective method. Application of the brace after removal of Kirschner wires has an important role in preventing the secondary deformity.

Adolescent ; Child ; Child, Preschool ; Female ; Hand Deformities ; etiology ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Syndactyly ; surgery ; Thumb ; abnormalities ; surgery

OBJECTIVETo introduce treatment method of replantation of severed thumb trauma with proximal arterial, and to evaluate its efficacy.

METHODSFrom February 2007 to March 2009,13 patients with severed thumb in serious injury of proximal arterial were treated with vein graft of volar forearm,bridging between dorsal carpal branch of radial artery on nasopharyngeal fossa and distal stump of ulnar proper digital artery. Among them, there were 11 males and 2 females with an average age of 34.5 years ranging from 16 to 50 years. Seven cases were in the left thumb,6 in the right thumb. Eight cases were complete separation, incomplete separation in 5 cases. Ten cases recieved emergency reimplantation, 3 cases with the arterial crisis after conventional replantation were explorated and repaired.

RESULTSThumb of 13 cases all survived. All patients were followed-up for 8 to 17 months (averaged, 11 months). Replantation thumb obtained satisfactory appearance. According to Chinese Medical Association Society of Hand Surgery Trial criteria, the results were excellent in 9 fingers, good in 3 fingers, 1 poor finger. Two point discrimination of finger pulp was 5 to 8 mm (averaged 6.5 mm).

CONCLUSIONBy repairing artery of thumb with vein graft of volar forearm, bridging between dorsal carpal branch of radial artery on nasopharyngeal fossa and distal stump of ulnar proper digital artery,complex severed thumb replants on surgery position comfortable,without affecting the blood supply of the hand, expanding the indications for replantation and improving the success rate of replantation.

Adult ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; surgery ; Replantation ; methods ; Thumb ; blood supply ; surgery ; Ulnar Artery ; surgery ; Young Adult

OBJECTIVETo investigate the optimal surgical timing and treatment of congenital duplication of the thumb in children.

METHODSA clinical study was performed on 154 fingers of the 132 patients (including 85 males, 47 females;mean age (1.53 +/- 2.47) years; ranged from 2 months to 13 years). Duplicated thumbs were surgically treated from December 2007 to February 2012. All patients underwent detailed physical examination and radiological assessment. Surgical methods should be selected according to the age, Wassel classification and deformity. The operation steps included resection of the most hypoplastic thumb, followed by skin flap plasty, tendon shift (transplantation) , reconstruction of collateral ligament and articular capsule. 11 cases over the age of 6 underwent osteotomy discretion as appropriate.

RESULTSA total of 117 fingers of the 104 patients were followed up for an average 36. 7 months (range,6-55 months). We adopted upgrade Tada standard to evaluate the follow-up results as excellent in 77 thumbs, good in 21 thumbs, fair in 15 thumbs and poor in 4 thumbs. Three thumbs appeared secondary angular deformity 2 years after operation and one thumb appeared residual osteoepiphysis in the radial side of metacarpophalangeal joint 3 years after operation. The appearance and the function were almost normal after second operation.

CONCLUSIONSThe optimal surgical timing of congenital duplication of thumb should be based on the appearance of thumb ossification center. The surgical timing of Wassel type- I and II should be chosen at 1. 5 years old when the ossification center of distal phalanx appears, Wassel type-III and IV should be chosen at 1 year old when the ossification center of proximal phalanx appears, Wassel type-V and VI should be chosen at 2. 5 years old when the ossification center of metacarpal appears, and Wassel type-VII should be chosen at 2. 5 years old. The surgical method should be selected on individualized principle. The key points are reconstruction of collateral ligament, tendon and articular capsule and correction of ulnar deviation (or radial deviation).

Adolescent ; Child ; Child, Preschool ; Female ; Hand Deformities ; surgery ; Humans ; Infant ; Male ; Polydactyly ; surgery ; Reconstructive Surgical Procedures ; methods ; Thumb ; abnormalities ; surgery