Free medial plantar perforator flaps for the resurfacing of finger and foot defects

In this article, three cases in which free medial plantar perforator flaps were successfully transferred for coverage of soft-tissue defects in the fingers and foot are described. This perforator flap has no fascial component and is nourished only by perforators of the medial plantar vessel and a cutaneous vein or with a small segment of the medial plantar vessel. The advantages of this flap are minimal donor-site morbidity, minimal damage to both the posterior tibial and medial plantar systems, no need for deep dissection, the ability to thin the flap by primary removal of excess fatty tissue, the use of a large cutaneous vein as a venous drainage system, a good color and texture match for finger pulp repair, short time for flap elevation, possible application as a flow-through flap, and a concealed donor scar.     

The free thoracoumbilical flap for resurfacing large soft-tissue defects of the lower extremity

Both cadavers and living patients were studied regarding a method to resolve large skin defects with bone exposure in the leg, with long-distance thrombosis of the anterior tibial vessels or posterior tibial vessels resulting from traumatic lesions. Forty-six casting mold specimens of cadaveric legs were investigated. There were rich communication branches among the anterior tibial artery, posterior tibial artery, and fibular artery in the foot and ankle, which complemented each other well. Twenty-six patients with large skin defects with bone exposure in the proximal or middle segment of the leg were admitted to the authors' hospital. Among those patients, 19 demonstrated long-distance thrombosis of the anterior tibial vessels or posterior tibial vessels resulting from traumatic lesions. During treatment, a thoracoumbilical flap based on the inferior epigastric vessels was anastomosed to the distal stump of the anterior tibial vessels or the posterior tibial vessels, with reversed flow. All defects were successfully repaired, with good color and texture matches of the flaps. This method can be used for patients with normal anterior tibial vessels or posterior tibial vessels, normal distal stumps of the injured blood vessels, and good reversed flow. The method has the advantages of dissecting blood vessels in the recipient area during the débridement, not affecting the blood circulation of the injured leg, not sacrificing blood vessels of the opposite leg, and not fixing the patient in a forced posture. The muscles are less bulky in the distal one-third of the leg, and the blood vessels are shallow and can be dissected and anastomosed easily. When the flap is used for reconstruction in the proximal two-thirds of the leg, the blood vessel pedicle of the free flap is at a straight angle, without kinking.     

Free tensor fasciae latae perforator flap for the reconstruction of defects in the extremities

In the three cases presented in this study, free tensor fasciae latae perforator flaps were used successfully for the coverage of defects in the extremities. This flap has no muscle component and is nourished by muscle perforators of the transverse branch of the lateral circumflex femoral system. The area of skin that can by nourished by these perforators is larger than 15 x 12 cm. The advantages of this flap include minimal donor-site morbidity, the preservation of motor function of the tensor fasciae latae muscle and fascia lata, the ability to thin the flap by removing excess fatty tissue, and a donor scar that can be concealed. In cases that involve transection of the perforator above the deep fascia, the operation can be completed in a very short period of time. This flap is especially suitable as a free flap for young women and children who have scars in the proximal region of the lateral thigh or groin region that were caused by split-thickness skin grafting or full-thickness skin grafting during previous operations.     

Osteocutaneous posterior interosseous flap for reconstruction of the metacarpal bone and soft-tissue defects in the hand

A vascularized bone segment of the ulna together with a posterior interosseous fasciocutaneous flap is harvested, including a cuff of the extensor pollicis longus muscle. The authors treated five male patients with metacarpal bone and soft-tissue defects of the hand using a distally based island osteocutaneous posterior interosseous flap. Their ages at the time of surgery ranged from 15 to 37 years (mean, 24 years). The bone defects were in the first metacarpal in three cases, the fourth metacarpal in one, and the fifth metacarpal in one. The length of the donated ulna ranged from 3 to 7 cm (mean, 5 cm). The follow-up period ranged from 5 to 92 months (mean, 39 months). All flaps survived completely. The posterior interosseous flap provides thin skin of good texture, together with vascularized bone, for a one-stage reconstruction of the metacarpal bone and soft-tissue defects in the hand.     

VY bipedicle flap for resurfacing the nasal supratip region

A procedure for the coverage of surgically created supratip defects up to 1.5 cm in diameter is described utilizing a VY bipedicle flap of nasal skin.     

Development of the hand and wrist bones in chimpanzees

Skeletal developmental of chimpanzees was studied cross-sectionally. By application of the TW2 method, we described the skeletal development of chimpanzees and compared their skeletal development with humans'. A development pattern of chimpanzees repeated accelerations and decelerations displaying “early-juvenile trough,” “pre-adolescent peak,” “mid-adolescent trough,” and “post-adolescent peak” in incremental curves. Sex differences in skeletal development are slower development in males during infant and early juvenile phases, and greater increment around the adolescent phase in males. Females are fully mature at younger ages than males, e.g. about one and a half years. In comparison with chimpanzees, humans have such characteristics as a longer slower period of juvenile development and a shorter spurt-like adolescent fast period which ends with full maturity.     

Comparison of three local frame definitions for the kinematic analysis of the fingers and the wrist

Because the hand is a complex poly-articular limb, numerous methods have been proposed to investigate its kinematics therefore complicating the comparison between studies and the methodological choices. With the objective of overcoming such issues, the present study compared the effect of three local frame definitions on local axis orientations and joint angles of the fingers and the wrist. Three local frames were implemented for each segment. The “Reference” frames were aligned with global axes during a static neutral posture. The “Landmark” frames were computed using palpated bony landmarks. The “Functional” frames included a flexion–extension axis estimated during functional movements. These definitions were compared with regard to the deviations between obtained local segment axes and the evolution of joint (Cardan) angles during two test motions. Each definition resulted in specific local frame orientations with deviations of 15° in average for a given local axis. Interestingly, these deviations produced only slight differences (below 7°) regarding flexion–extension Cardan angles indicating that there is no preferred method when only interested in finger flexion–extension movements. In this case, the Reference method was the easiest to implement, but did not provide physiological results for the thumb. Using the Functional frames reduced the kinematic cross-talk on the secondary and tertiary Cardan angles by up to 20° indicating that the Functional definition is useful when investigating complex three-dimensional movements. Globally, the Landmark definition provides valuable results and, contrary to the other definitions, is applicable for finger deformities or compromised joint rotations.     

A device for assessment of hand and wrist coronal plane strength

Diagnostic and rehabilitative assessments of hand function commonly omit measurement of twisting strength even though many activities of daily living require turning handles, lids, and objects of many sizes. A simple device to quantify twisting strength was designed and constructed to establish normative data and test hypotheses about hand function. The instrument is easy to use and includes an electronic torsional load cell and disks of several sizes. Tests were conducted on the dominant and nondominant hands of 64 normal subjects and 13 arthritic patients with arthritis of the thumb carpometacarpal joint. Hands were tested with disks ranging in diameter from 2.5 to 12.5 cm. A three-way repeated measures analysis showed that gender (p < 0.001), handedness (p < 0.001), and disk size (p < 0.001) had significant effects. There was no difference between radial and ulnar deviation strengths (p = 0.365). The arthritic group had significantly reduced strength (p < 0.02). Nine subjects were tested twice, with 1 day between tests: no differences occurred between the first and second testing (p = 0.930). The ability to distinguish the test groups with reproducible results proves that the device fulfills all basic requirements; continued testing and development are warranted.     

The venous skin graft method for repairing skin defects of the fingers

A venous skin graft for the treatment of skin defects in a finger is described. This procedure involves taking a flap from the forearm together with the subcutaneous vein and anastomosing both ends of this vein to the digital artery and vein, respectively. Thirteen difficult finger wounds were resurfaced with such a venous skin graft. The sizes of the flaps ranged from 1.3 X 3.0 cm to 2 X 5 cm. The lengths of the veins taken were from 6 to 12 cm. Subcutaneous fat is thin, and there is good elasticity in the grafted flap.