BACKGROUND: A pincer nail is characterized by the presence of an excessively curved and distorted nail across the transverse dimension. A multitude of therapeutic modalities have been implemented to treat this condition with limited efficacy. OBJECTIVE: We sought to evaluate the efficacy of surgery for pincer nail deformity with the use of the nail bed flap and bilateral partial matrixectomy, with or without osteophyte removal. METHODS: Nine patients (four patients: both great toe nails, five patients: single toe nail) with pincer nail deformities were treated with nail bed flap and bilateral partial matrixectomy, with or without osteophyte removal. Objective assessment was evaluated by use of the width index (width of the nail tip/width of the nail root) and height index (height of the nail tip/width of the nail tip). Subjective assessment was evaluated through patient global assessment (PGA) and use of the pain visual analogue scale as declared by patients. In addition, wound complications and recurrences were described. RESULTS: The width index and height index were improved (width index: 85.5%-->97%, height index: 54.3%-->3.4%). All of the patients claimed 'good' or higher in the PGA score. Relief of pain was shown in 100% of the cases. There was no recurrence during a 6- to 20-month period (mean time: 11.8 months) and no complications. CONCLUSION: Nail bed flap and bilateral partial matrixectomy with or without osteophyte removal as a surgical approach might be an effective and curative method of treatment for pincer nail deformity.
Congenital Abnormalities ; Humans ; Osteophyte* ; Recurrence ; Toes ; Wounds and Injuries

Adhesion formed between tendon and its sheath after repair often impairs functional recovery. There have been many attempts to reduce adhesion around a repaired tendon, but most results have been unsatisfactory or impractical in clinical application. Moreover, most attempts were focused on extrinsic tendon healing. whereas studies on the intrinsic tendon healing are sacrce in the literature. We have previously reported that fibrotic tendon adhesion after repair was decreased by decorin, a natural inhibitor of TGF-beta. Accordingly, the serial tensile strength was measured after complete tensection and repair of the tendon severance in order to confirm the effect of decorin inhibition of intrinsic healing capability. Forty White Leghorn chickens were subject to complete transection and repair of the third toe flexor digitorum profundus tendon in Zone II. In the experimental group, 0.5ml of diluted decorin(50microgram/ml) was injected around the repaired site, and the same volume of saline solution in the control group. Tendons were harvested at 1, 3, 5 and 7 weeks. The disrupting force of the repair site was analyzed using tensiometry(LLOYD LR 30K, U.K). The tensile strength of repaired tendon was similar in both groups for all postoperative periods. This indicates that intrinsic healing proceeds normally within the decorin group in spite of the blockade of TGF-betaactivity. Decorin, a natural inhibitor of TGF-beta, showed a significant inhibitory effect on reducing post-repair tendon adhesions, without disruption of intrinsic healing in the chicken flexor tendon injury model. Therefore, decorin is expected to be a useful agent for preventnion on tendon adhesion after the repair in clinical usage.
Chickens ; Decorin* ; Postoperative Period ; Sodium Chloride ; Tendon Injuries ; Tendons* ; Tensile Strength* ; Toes ; Transforming Growth Factor beta

We observed a 55-year-old man who had granuloma pyogenicum on the medial border of the right fifth toe which developed after scratching of the wound. Histopathological findings showed many newly formed capillaries that had prominant endothelial cells and showed varying degrees of dilation without appearance of epidermal collarette signs. We tried intralesional treatment with triamcinolone acetonide (10mg%, 1/week*3). After 3 sessions of treatment, the lesion dramatically regressed nearly to normal size.
Capillaries ; Endothelial Cells ; Granuloma* ; Granuloma, Pyogenic* ; Humans ; Middle Aged ; Toes ; Triamcinolone Acetonide* ; Triamcinolone* ; Wounds and Injuries

The femoropopliteal arterial bypass is one of the most widely used vascular procedures for arterial reconsturctions of infrainguinal region. We performed 71 femoropopliteal bypass operations in 54 patients from January 1993 to December 1995 at the Dept. of surgery, Kangnam St. Mary's Hospital in Catholic University Medical College. We reviewed these patients retrospectively with admission and out paient charts with following results. 1) Most of patients were male in 50(92.6%) with peak incidence in the seventh decade 29(53.7%). 2) The etiologies were artherosclerosis obliterans(ASO) in 92.6% and thromboangitis obliterans(TAO) in 7.4%. 3) The associated diseases were 31 hypertensions (57.4%), 18 diabetes mellitus(33.3%), 3 chronic renal failures(5.6%), 2 abdominal aortic aneurysms(3.7%) and 2 cerebrovascular accidents(3.7%). 4) We used PTFE(polytetrafluoroethylene) synthetic graft in 65 cases and autogenous saphenous vein in 7 cases for graft material. 5) The inflow procedures were performed simultaneously in 36 cases(50.7%), which were 26 aortobifemoral bypasses, 7 iliofemoral bypasses, 2 AAA(abdominal aorta aneurysm) repairs and 1 aortobiliac bypass. The additional outflow procedures were performed in 6 cases; 4 Taylor's patches and 2 Miller's cuffs. 6) The primary patency rate at six months 93.3%, one year 87.3%,two years 68.3%, three years 48.8% and the secondary patency rate at six months was 93.8%, one year 87.3%, two years 71.2%, three years 61.1. 7) The complications after bypass were 6 wound problems, 3 major amputations, 1 lymphatic leakage, but there were no death cases.Even though our primary patency rate of the femoropopliteal bypass was somewhat poorer than that of reported foreign data, we could find secondary patency rate was acceptable with others by aggressive vascular approaches. After femoropopliteal bypass, even consecutive below knee vascular reconstruction, poor vasculatures were seemed to be the leading cause to major amputations and toe amputations. Further clinical study should be followed in the future.
Amputation ; Aorta ; Humans ; Incidence ; Knee ; Male ; Retrospective Studies ; Saphenous Vein ; Toes ; Transplants ; Wounds and Injuries

OBJECTIVE: The purpose of this study is to determine whether the changes of contralateral sensorimotor cortical activation on functional magnetic resonance imaging (fMRI) can predict the neurological outcome among spinal cord injury (SCI) patients when the great toes are stimulated without notice. METHODS: This study enrolled a total of 49 patients with SCI and investigated each patient's preoperative fMRI, postoperative fMRI, American Spinal Injury Association (ASIA) score, and neuropathic pain occurrence. Patients were classified into 3 groups according to the change of blood oxygenation level dependent (BOLD) response on perioperative fMRI during proprioceptive stimulation with repetitive passive toe movements : 1) patients with a response of contralateral sensorimotor cortical activation in fMRI were categorized; 2) patients with a response in other regions; and 3) patients with no response. Correlation between the result of fMRI and each parameter was analyzed. RESULTS: In fMRI data, ASIA score was likely to show greater improvement in patients in group A compared to those belonging to group B or C (p<0.001). No statistical significance was observed between the result of fMRI and neuropathic pain (p=0.709). However, increase in neuropathic pain in response to the signal change of the ipsilateral frontal lobe on fMRI was statistically significant (p=0.030). CONCLUSION: When there was change of BOLD response at the contralateral sensorimotor cortex on perioperative fMRI after surgery, relief of neurological symptoms was highly likely for traumatic SCI patients. In addition, development of neuropathic pain was likely to occur when there was change of BOLD response at ipsilateral frontal lobe.
Asia ; Brain* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Neuralgia ; Oxygen ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries ; Toes

OBJECTIVE: To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed. METHODS: Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases. RESULTS: All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes. CONCLUSION The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.
Male ; Female ; Humans ; Adult ; Nails/injuries* ; Plastic Surgery Procedures ; Finger Injuries/surgery* ; Surgical Flaps/innervation* ; Skin Transplantation/methods* ; Toes/injuries* ; Soft Tissue Injuries/surgery* ; Treatment Outcome

BACKGROUND: Buddy taping is a well known and useful method for treating sprains, dislocations, and other injuries of the fingers or toes. However, the authors have often seen complications associated with buddy taping such as necrosis of the skin, infections, loss of fixation, and limited joint motion. To our knowledge, there are no studies regarding the complications of buddy taping. The purpose of this study was to report the current consensus on treating finger and toe injuries and complications of buddy taping by using a specifically designed questionnaire. METHODS: A questionnaire was designed for this study, which was regarding whether the subjects were prescribed buddy taping to treat finger and toe injuries, reasons for not using it, in what step of injury treatment it was use, indications, complications, kinds of tape for fixation, and special methods for preventing skin injury. Fifty-five surgeons agreed to participate in the study and the survey was performed in a direct interview manner at the annual meetings of the Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand, in 2012. RESULTS: Forty-eight surgeons (87%) used buddy taping to treat finger and toe injuries, especially proximal interphalangeal (PIP) injuries of the hand, finger fractures, toe fractures, metacarpophalangeal injuries of the hand, and PIP injuries of the foot. Sixty-five percent of the surgeons experienced low compliance. Forty-five percent of the surgeons observed skin injuries on the adhesive area of the tape, and skin injuries between the injured finger and healthy finger were observed by 45% of the surgeons. CONCLUSIONS: This study sheds light on the current consensus and complications of buddy taping among physicians. Low compliance and skin injury should be considered when the clinician treats finger and toe injuries by using buddy taping.
Adult ; Finger Injuries/*therapy ; Foot Injuries/*therapy ; *Fracture Fixation/adverse effects/methods ; Humans ; Middle Aged ; Physicians/statistics & numerical data ; Questionnaires ; Splints/*adverse effects ; Surgical Tape ; Toes/*injuries

OBJECTIVETo report the application of reverse second dorsal metatarsal artery island flap for From May 2005 to September 2008, 5 cases with soft tissue repairing the soft tissue defect at toes.

METHODSdefects at toes were treated with reverse second dorsal metatarsal artery island flaps. The flaps size ranged from 2 cm x 3 cm to 5 cm x 6 cm.

RESULTSAll the 5 flaps survived completely. The patients could walk 1-2 months after operation. The patients were followed up for 5-7 months with good appearance, texture and sensation of toes.

CONCLUSIONThe reverse second dorsal metatarsal artery island flap has a reliable blood supply and good tissue texture. It is a practical method for repairing the soft tissue defect at toes.

Adult ; Fascia ; transplantation ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Toes ; injuries ; Young Adult

OBJECTIVETo investigate the clinical effect of reversed plantar metatarsal artery island flap in repairing the plantar soft tissue defects at the first and second toes.

METHODS12 cases with plantar soft tissue defects at the first and second toes were repaired by reversed plantar metatarsal artery island flap which size ranged from 2 cm x 3 cm to 4 cm x 6 cm, including 5 cases at emergency, 5 cases with the donor site defects at great toes after free lateral pulp flap transfer, and 2 cases with the donor site defects at second toes after free medial pulp flap transfer.

RESULTSAll the reversed plantar metatarsal artery island flaps at the first and second toes survived uneventfully with desirable appearance and sensation over a 3-35 month follow-up. No complication happened at the donor sites.

CONCLUSIONSIt is an reliable method to adopt the reversed plantar metatarsal artery island flap for the plantar soft tissue defects at the first and second toes, with the advantages of stable blood vessels, high survival rate, good skin texture and few complications.

Arteries ; Foot ; Humans ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; transplantation ; Toes ; Transplant Donor Site ; blood supply

BACKGROUND: Full-thickness nail bed defects with significant exposure of the distal phalanx are typically challenging to reconstruct. We describe a novel method of nail bed defect reconstruction using a thenar fascial flap combined with nail bed grafting. METHODS: Full-thickness nail bed defects were reconstructed in a 2-stage operation involving the placement of a thenar fascial flap and subsequent nail bed grafting. A proximally-based skin flap was designed on the thenar eminence. The flap was elevated distally to proximally, and the fascial layer covering the thenar muscle was dissected proximally to distally. The skin flap was then closed and the dissected fascial flap was turned over (proximal to distal) and inset onto the defect. The finger was immobilized for 2 weeks, and the flap was dressed with wet and ointment dressings. After 2 weeks, the flap was divided and covered with a split-thickness nail bed graft from the great toe. Subsequent nail growth was evaluated on follow-up. RESULTS: Nine patients (9 fingers) treated with the novel procedure were evaluated at follow-up examinations. Complete flap survival was noted in all cases, and all nail bed grafts took successfully. Five outcomes (55.6%) were graded as excellent, three (33.3%) as very good, and one (11.1%) as fair. No donor site morbidities of the thenar area or great toe were observed. CONCLUSIONS: When used in combination with a nail bed graft, the thenar fascial flap provides an excellent means of nail bed reconstruction.
Bandages ; Fascia ; Finger Injuries ; Fingers ; Follow-Up Studies ; Humans ; Methods ; Reconstructive Surgical Procedures ; Skin ; Surgical Flaps ; Tissue Donors ; Toes ; Transplants