Various types of tumor can occur in the subungual space, including glomus tumors, subungual exostosis, hemangioma, epidermal cysts, and malignant tumors. While fibromatosis can occur at various sites throughout the body, it is very rarely seen in the toe. Here, we are the first to report a case of superficial fibromatosis mimicking a glomus tumor in the subungual space of the second toe. The presentation of this condition shows the possibility of encountering uncommon superficial fibromatosis in the distal phalanx of the toe, and suggests that superficial fibromatosis should be included in the differential diagnosis of a glomus tumor in the toe.
Adult ; *Fibroma ; *Glomus Tumor ; Humans ; Male ; *Osteochondroma ; *Toes/pathology/surgery

OBJECTIVETo investigate difference between the appearance and the bony structure in the polysyndactyly of the fifth toe fused with the fourth toe.

METHODSFrom Jan. 2009 to Jan. 2014, 54 patients (65 feet) with polysyndactyly of the fifth toe fused with the fourth toe were treated. The appearance, X-ray and intraoperative finding were recorded and compared to classify the deformity. Then the extra toe was excised and syndactyly was separated. The malalignment and brachydactyly of the sixth toes were corrected simultaneously.

RESULTSAccording to the bone and joint type, the fifth toes were neoplastic toes without joints in 17 feet, or had poor bony and joint alignment with the sixth toes in 48 feet. So the fifth toes were excised in all the cases. The patients were followed up for 1 month to 4 years. The oblique deformity of sixth toes were corrected completely with improved length.

CONCLUSIONSThe polysyndactyly of the fifth toe fused with the fourth toe should be classified to design the excised toe (usually fifth toe) and correction procedure. The appearance and bony joint recovery are both important.

Humans ; Polydactyly ; pathology ; surgery ; Syndactyly ; pathology ; surgery ; Toe Phalanges ; abnormalities ; surgery ; Toes ; abnormalities ; surgery

Because wide swings in temperature can occur during cardiac anesthesia all patients undergoing cardiac anesthesia should have their temperatures monitered. This is especially true in situations where deliberate hypothermia during cardiopulmonary surgery is an area of controversy. This study of 20 cases of open heart surgery was undertaken to compare the changes in tympanic membrane, nasopharyngeal, rectal and great toe temperatures and of to evaluate their correlation during the induction, cardiopulmonary bypass, rewarming and post-cardiopulmonary bypass periods. The temperature at each site was monitored every 10 minutes for 60 minutes of each period. The results were as follows, During the induction period, the temperature of the tympanic membrane, nasopharynx and rectum decreased significantly(p<0.05~p<0.01), but the temperatures of the great toe temperatures increased for 20 minutes and then slowly decreased during the next 30 to 60 minutes. During the cardiopulmonary bypass period, the sympanic membrane temperatures which were best correlated with the nasopharyngeal temperatures(p<0.05~p<0.01), decreased faster than the rectal, nasopharyngeal and great toe temperatures. During the rewarming period, the tympanic membrane temperatures increased most quickly and were significantly correlated with the nasopharyngeal temperatures(p<0.05) only at 0 and 10 minutes. During the post-cardiopulmonary bypass period, the tympanic membrane and nasopharyngeal temperatures decreased slowly and were significantly correlated with each other(p<0.01), but the rectal and the great toe temperatures increased slowly.
Anesthesia* ; Cardiopulmonary Bypass ; Heart* ; Humans ; Hypothermia ; Membranes ; Nasopharynx ; Rectum ; Rewarming ; Thoracic Surgery* ; Toes ; Tympanic Membrane

Adult ; Female ; Hand ; surgery ; Humans ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Toes ; transplantation

BACKGROUND: The amplitude (AMP) of Photoplethysmogram (PPG) is used as a marker of vasodilatation. The pulse transit time (PTT), which shows a good correlation with blood pressure (BP), is not strong enough to detect the changes in BP. This study examined the sensitivity of the combined effect of the finger and toe AMP, and the PTT of PPG as a marker of the changes in BP during general anesthesia. METHODS: Forty patients receiving maxillofacial surgery under general anesthesia were enrolled in this study. During surgery, the intra-arterial BP, ECG, finger and toe PPG signals were measured. Using the R-wave from the ECG, the AMP and PTT was derived from PPG data. The correlation between BP and PPG parameters (AMP and PTT) were compared. New parameters that show high correlation with the BP were found. Regression equations for calculating the BP using the PPG parameters were formulated. RESULTS: The new parameter, log (fingerAMP/toeAMP), showed the highest correlation in each patient (mean correlation coefficient in the systolic BP: -0.846, diastolic BP: -0.858). However, when the data from all 40 patients were combined, the correlation coefficient of the toe PTT was highest (systolic BP: -0.726, diastolic BP: -0.646). The regression equation showed the highest correlation between the actual BP and calculated BP when the toe PTT and log (fingerAMP/toeAMP) were included. CONCLUSIONS: The AMP of the toe and finger PPG can be used to estimate the invasive continuous blood pressure.
Anesthesia, General ; Blood Pressure* ; Electrocardiography ; Fingers* ; Humans ; Pulse Wave Analysis* ; Surgery, Oral ; Toes* ; Vasodilation

BACKGROUNDFingertip defect significantly affects the appearance of the hand. The aim of this research was to evaluate the clinical effect of aesthetic fingertip reconstruction with partial second toe transfer.

METHODSBetween July 2005 and December 2008, 17 patients underwent aesthetic fingertip reconstruction with partial second toe transfer. The mean size of fingertip defects was 0.7 cm (ranging from 0.5 - 1.1 cm). Anastomosis was performed between one dominant plantar digital artery and one proper digital artery, between two dorsal digital veins of the toe and two dorsal digital veins of the finger, respectively, for the reconstruction of blood supply to the reconstructed finger. Two plantar digital nerves of the toe were then sutured to two proper digital nerves of the finger for the restoration of fingertip sensation.

RESULTSAll reconstructed fingers survived completely. The follow-up period ranged from 6 to 24 months, and the appearance of the reconstructed fingertip was similar to that of the normal fingertip. Two-point discrimination of the reconstructed fingertip was (7.8 ± 1.3) mm. The recovered pinch strength of the reconstructed finger was about (89.0 ± 5.1)% of that of the normal finger. Donor site healed well without complications.

CONCLUSIONSPartial second toe transfer is an ideal aesthetic reconstruction method for fingertip defects; it can not only achieve a satisfactory appearance of the fingertip, but can also obtain excellent sensory and motor functions.

Adolescent ; Adult ; Antisepsis ; Female ; Fingers ; blood supply ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Toes ; transplantation

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Surgical Flaps ; Thumb ; surgery ; Toes

Objective: To compare the effects between second toe tibial dorsal artery flap (2-TDAF) and second toe tibial plantar proper artery flap (2-TPPAF) in repairing finger skin and soft tissue defects. Methods: A retrospective cohort study was conducted. From January 2019 to June 2020, 27 patients with skin and soft tissue defects at the fingertips with area of 1.5 cm×1.2 cm-2.6 cm×1.8 cm after debridement who met the inclusion criteria were admitted to Suzhou Ruihua Orthopaedic Hospital, including 21 males and 6 females, aged 19-59 (37±10) years. According to flap repair methods used in the defective fingers, the patients were divided into 2-TDAF group (12 cases) and 2-TPPAF group (15 cases). The area of 2-TDAF ranged from 1.5 cm×1.2 cm to 2.5 cm×1.6 cm, and the area of 2-TPPAF ranged from 1.7 cm×1.3 cm to 2.6 cm×1.8 cm. Full-thickness skin grafts from the medial side of the ipsilateral leg were grafted to the wounds in donor sites, and the wounds in donor sites of skin grafts were directly sutured. Flap arterial diameter, flap excision time, flap survival situation of patients in 2 weeks after operation, and follow-up time were recorded. At the last follow-up, the two-point discrimination distance of flap graft site, total action motion (TAM) of the finger joints, and wound healing of the flap donor site were recorded; the Vancouver scar scale (VSS) was used to score the scar in donor area of the second toe and the recipient area of fingers; the appearance and self-satisfaction subscales of the Michigan hand outcomes questionnaire (MHQ) were used to evaluate the affected finger. Data were statistically analyzed with independent sample t test or Fisher's exact probability test. Results: The flap artery diameter of patients in 2-TDAF group was 0.35-0.80 (0.56±0.14) mm and the flap cutting time was (14.0±2.7) min, which were significantly shorter than 0.80-1.35 (1.02±0.16) mm and (19.7±3.4) min in 2-TPPAF group (with t values of 7.81 and 4.79, respectively, P<0.01). The flaps of patients in the 2 groups in recipient areas survived well in 2 weeks after operation, and the wounds in donor areas of flaps of patients in the 2 groups healed well at the last follow-up. There was no statistically significant difference in the postoperative follow-up time, and two-point discrimination distance of flap graft site, TAM of the finger joints, VSS score of scar in the second toe donor site and the finger recipient site, and the appearance and self-satisfaction of MHQ scores of the affected finger at the last follow-up (P>0.05). Conclusions: Compared with 2-TPPAF, 2-TDAF has a shallower anatomical layer and shorter time for surgical flap removal, which can preserve the proper arteries and nerves at the base of the toes and reduce the damage to the donor site.
Male ; Female ; Humans ; Soft Tissue Injuries/surgery* ; Finger Injuries/surgery* ; Cicatrix/surgery* ; Plastic Surgery Procedures ; Retrospective Studies ; Treatment Outcome ; Surgical Flaps ; Skin Transplantation ; Toes/surgery* ; Arteries ; Perforator Flap

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

OBJECTIVETo study the methods and therapeutic effect of repairing deformity of nasal columella and tip by anastomosing its blood vessels with those of the great/second toe web flap.

METHODSThe donor site was the great/second toe web flap. Sewing the great/second toe web flap and nasal columella and tip together by using 5-0 silk thread, anatomizing facial artery and facial vein for three centimeters long behind submaximal, protecting lower jaw branch of facial nerve, separating a subcutaneous layer tunnel between nasal columella and one of facial artery and facial vein behind submaximal. Dorsal artery of foot, saphenous vein in the flap were anastomosed with the facial artery and facial vein behind submaximal through the tunnel under the subcutaneous layer.

RESULTSAll flaps survived, satisfactory therapeutic effect was obtained. Postoperative follow-up was 0.5-1 year. The reconstructed columella showed satisfactory contour, good texture and color, and good resistance to injury.

CONCLUSIONSGreat/second toe web flap is a ideal skin flap for repairing deformity of nasal columella and tip.

Adult ; Female ; Humans ; Male ; Middle Aged ; Nose ; pathology ; surgery ; Skin Transplantation ; Surgical Flaps ; Toes ; surgery ; Young Adult