OBJECTIVE: To explore the method and effectiveness of index finger proximal dorsal island flap supplied by the nutrient vessels of superficial branch of radial nerve for treatment of thumb skin and soft tissue defect. METHODS: Between August 2019 and December 2024, 12 patients with thumb skin and soft tissue defects caused by trauma accompanied by variation of the first dorsal metacarpal artery were treated. There were 8 males and 4 females, aged 19-55 years, with an average age of 32 years. The wound area ranged from 2.2 cm×2.0 cm to 5.5 cm×3.5 cm. The time from injury to operation ranged from 1.5 to 6.0 hours, with an average of 4.5 hours. After thorough debridement, the wound was repaired with a index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve. The flap area ranged from 2.4 cm×2.2 cm to 6.0 cm×4.0 cm. The donor site was repaired with free skin grafting. Regular follow-up was conducted postoperatively to observe the appearance, texture, sensory recovery of the flap, and the condition of the donor site. RESULTS: The operation time ranged from 30 to 72 minutes, with an average of 47 minutes; intraoperative blood loss ranged from 30 to 70 mL, with an average of 46 mL. After operation, partial necrosis occurred at the skin edge of the radial incision on the dorsum of the hand in 1 case, which healed after dressing changes; all other flaps survived uneventfully, with primary wound healing. The skin grafts at the donor sites all survived. All 12 patients were followed up 5-36 months, with an average of 14 months. The appearance and texture of the flaps were good. At last follow-up, the two-point discrimination of the flaps ranged from 4 to 9 mm, with an average of 5.2 mm. According to the functional evaluation criteria for upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 11 cases and good in 1 case. No scar contracture, pain, or joint movement limitation was observed at the donor sites. CONCLUSION For patients with skin and soft tissue defects of the thumb accompanied by variation of the first dorsal metacarpal artery, the index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve can be selected. This method has advantages such as shorter operation time, less intraoperative bleeding, and good postoperative appearance and sensation of the flap.
Humans ; Male ; Adult ; Female ; Thumb/surgery* ; Soft Tissue Injuries/surgery* ; Radial Nerve/surgery* ; Middle Aged ; Surgical Flaps/innervation* ; Plastic Surgery Procedures/methods* ; Skin Transplantation/methods* ; Young Adult ; Treatment Outcome ; Fingers/surgery* ; Skin/injuries*

OBJECTIVE: To investigate the effectiveness of endoscopic-assisted median nerve decompression with one-stage extensor indicis proprius (EIP) tendon transfer for reconstruction of thumb abduction in patients with severe carpal tunnel syndrome (CTS). METHODS: The clinical data of 12 patients with severe CTS who met the selection criteria between December 2019 and December 2024 were retrospectively analyzed. There were 2 males and 10 females with an average age of 55.4 years ranging from 35 to 67 years. The symptom duration of CTS was 12-120 months (mean, 48.7 months) and the thenar muscle atrophy duration was 6-48 months (mean, 13.4 months). The median nerve was released with the help of endoscope, and the EIP tendon was transferred to reconstruct the abduction function of the thumb. The operation time and complications were recorded. Two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, and pinch force of the thumb were measured and compared before operation and at last follow-up, and the effectiveness was evaluated by Kapandji score and Disabilities of the Arm, Shoulder and Hand (DASH) score. The satisfaction of the operation was evaluated at last follow-up. RESULTS: All surgeries were successfully completed with a mean operation time of 54 minutes (range, 45-68 minutes). All patients were followed up 6-50 months, with an average of 15.3 months. There was no complications such as wound infection, scar pain of wrist, or tendon rupture of transposition, and there were 3 cases of mild limitation of finger extension in the donor site of index finger. At last follow-up, two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, Kapandji score, and DASH score were significantly better than those before operation ( P<0.05), but there was no significant difference in thumb pinch force between pre- and post-operation ( P>0.05). The evaluation of surgical satisfaction showed that 7 cases were very satisfied and 5 cases were satisfied. CONCLUSION The combination of endoscopic-assisted median nerve decompression and one-stage EIP tendon transfer effectively improves hand function and quality of life in patients with severe CTS by restoring thumb abduction and alleviating neurological symptoms.
Humans ; Tendon Transfer/methods* ; Male ; Middle Aged ; Carpal Tunnel Syndrome/physiopathology* ; Female ; Decompression, Surgical/methods* ; Aged ; Adult ; Thumb/physiopathology* ; Endoscopy/methods* ; Retrospective Studies ; Median Nerve/surgery* ; Treatment Outcome ; Plastic Surgery Procedures/methods*

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

Objective: To explore the clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns. Methods: A retrospective observational study was conducted. From May 2018 to April 2021, 12 male patients with thumb destructive defects caused by electrical burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, aged 27 to 58 years, including 10 cases with degree Ⅲ thumb defect and 2 cases with degree Ⅳ thumb defect after thorough debridement. The thumb was reconstructed with free hallux-nail flap combined with composite tissue flap of the second phalangeal bone, joint, and tendon with skin island. The donor site of hallux-nail flap was covered with artificial dermis in the first stage and performed with continuous vacuum sealing drainage, and covered with medium-thickness skin graft from the groin site in the second stage. The donor site in the second toe was filled and fixed with iliac bone strips. The survival of reconstructed thumb was observed 1 week after the reconstruction surgery, the survival of skin graft in the donor site of hallux-nail flap was observed 2 weeks after skin grafting, and the callus formation of the reconstructed thumb phalanx and the second toe of the donor foot was observed by X-ray 6 weeks after the reconstruction surgery. During the follow-up, the shape of reconstructed thumb was observed and the sensory function was evaluated; the function of reconstructed thumb was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; whether the interphalangeal joints of the hallux and the second toe were stiff, the scar hyperplasia of the foot donor site, and whether the walking and standing functions of the donor feet were limited were observed. Results: One week after the reconstruction surgery, all the reconstructed thumbs of the patients survived. Two weeks after skin grafting, the skin grafts in the donor site of hallux-nail flap of 11 patients survived, while the skin graft in the donor site of hallux-nail flap of 1 patient was partially necrotic, which was healed completely after 10 days' dressing change. Six weeks after the reconstruction surgery, callus formation was observed in the reconstructed thumb and the second toe of the donor foot of 10 patients, the Kirschner wires were removed; while callus formation of the reconstructed thumb was poor in 2 patients, and the Kirschner wires were removed after 2 weeks of delay. During the follow-up of 6 to 24 months, the shape of reconstructed thumb was similar to that of the healthy thumb, the discrimination distance between the two points of the reconstructed thumb was 7 to 11 mm, and the functional evaluation results were excellent in 4 cases, good in 6 cases, and fair in 2 cases. The interphalangeal joints of the hallux and the second toe of the donor foot were stiff, mild scar hyperplasia was left in the donor site of foot, and the standing and walking functions of the donor foot were not significantly limited. Conclusions: The application of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns adopts the concept of reconstruction instead of repair to close the wound. It can restore the shape and function of the damaged thumb without causing great damage to the donor foot.
Burns, Electric/surgery* ; Cicatrix/surgery* ; Free Tissue Flaps ; Hallux/surgery* ; Humans ; Hyperplasia ; Male ; Reconstructive Surgical Procedures/methods* ; Skin Transplantation/methods* ; Thumb/surgery* ; Toes/surgery* ; Treatment Outcome

Objective: To explore the clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects. Methods: A retrospective observational study was conducted. From August 2016 to August 2019, 7 patients with thumb or finger defects caused by mechanical damage who met the inclusion criteria were admitted to Ruihua Affiliated Hospital of Soochow University, including 6 males and 1 female, aged 46 to 58 years. Their length of fingers was repaired with iliac bone, with length of 2.0 to 3.0 cm. After the bone graft, the skin defect area of the affected finger ranged from 2.8 cm×2.2 cm to 6.0 cm×3.2 cm. Then the free proximal ulnar artery perforator flap with area of 3.0 cm×2.4 cm to 6.5 cm×3.5 cm was used to cover the wounds. The wounds in donor sites of iliac crest and flap were directly sutured. The survival of flap in one week post surgery and the donor site wound healing in 2 weeks post surgery were observed, respectively. During the follow-up, the appearance and sensory function of the affected finger, bone healing, and scar hypertrophy of wound in the donor site were observed and evaluated. At the last follow-up, the functional recovery of the affected finger was evaluated with trial standard for the evaluation of functions of the upper limbs of the Hand Surgery Society of Chinese Medical Association. Results: In one week post surgery, all the flaps survived. In 2 weeks post surgery, the iliac bone and the wounds in forearm donor site healed. During the follow-up of 5 to 13 months, the flap was good in appearance, without obvious pigmentation; the sensory recovery reached level S₂ in 5 patients and S₀ in 2 patients; all the grafted iliac bones were bony union without obvious resorption; the wounds in donor site healed well, with only mild scar formation. At the last follow-up, the shape of the reconstructed finger was close to the healthy finger, and the functional evaluation results were excellent in 3 cases and good in 4 cases. Conclusions: The use of proximal ulnar artery perforator flap combined with iliac bone graft to reconstruct subtotal thumb or finger can partially restore part of the appearance and function, with less damage to the donor site. It is a good choice for patients who have low expectations of appearance and function for the reconstructed finger.
Male ; Humans ; Female ; Soft Tissue Injuries/surgery* ; Perforator Flap/transplantation* ; Skin Transplantation/methods* ; Thumb/surgery* ; Plastic Surgery Procedures ; Ulnar Artery/surgery* ; Cicatrix/surgery* ; Ilium/surgery* ; Treatment Outcome

BackgroundHand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities.

MethodsSixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed.

ResultsThe normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons.

ConclusionsSports injury-related fingers and thumb deformity are relatively common. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb. It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.

Adult ; Athletic Injuries ; diagnosis ; surgery ; Female ; Hand Deformities ; diagnosis ; surgery ; Humans ; Ligaments ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Metacarpophalangeal Joint ; diagnostic imaging ; surgery ; Middle Aged ; Soft Tissue Injuries ; diagnostic imaging ; surgery ; Tendon Injuries ; diagnostic imaging ; surgery ; Thumb ; abnormalities ; surgery

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*

Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extra- articular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint has been previously reported. We report the second case report of this injury in a 20-year-old man. The patient had an excellent outcome after treatment.
Adult ; Fractures, Bone ; surgery ; Humans ; Joint Dislocations ; surgery ; Male ; Metacarpal Bones ; injuries ; Metacarpophalangeal Joint ; injuries ; Thumb ; injuries

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

BACKGROUND: Suspension ligamentoplasty using abductor pollicis longus (APL) tendon without bone tunneling, was introduced as one of the techniques for treatment of advanced first carpometacarpal (CMC) arthritis. The purpose of this study was to evaluate the radiologic and clinical results of APL suspension ligamentoplasty. METHODS: The medical records of 19 patients who underwent APL suspension ligamentoplasty for advanced first CMC arthritis between January 2008 and May 2012 were reviewed retrospectively. The study included 13 female and 6 male patients, whose mean age was 62 years (range, 43 to 82 years). For clinical evaluation, we assessed the grip and pinch power, radial and volar abduction angle, thumb adduction (modified Kapandji index), including visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiologic evaluation was performed using simple radiographs. RESULTS: The mean follow-up was 36 months (range, 19 to 73.7 months). Mean power improved from 18.3 to 27 kg for grip power, from 2.8 to 3.5 kg for tip pinch, and from 4.3 to 5.4 kg for power pinch. All patients showed decreased VAS from 7.2 to 1.7. Radial abduction improved from 71degrees preoperatively to 82degrees postoperatively. The modified Kapandji index showed improvement from 6 to 7.3, and mean DASH was improved from 41 to 17.8. The height of the space decreased from 10.8 to 7.1 mm. Only one case had a complication involving temporary sensory loss of the first dorsal web space, which resolved spontaneously. CONCLUSIONS: The APL suspension ligamentoplasty for treatment of advanced first CMC arthritis yielded satisfactory functional results.
Adult ; Aged ; Aged, 80 and over ; Carpometacarpal Joints/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteoarthritis/*surgery ; Postoperative Complications ; Retrospective Studies ; Tendons/*surgery ; Thumb/*surgery