Experimental Investigation into Soil-Cutting Performance of the Claws of Mole Rat (Scaptochirus moschatus)

The geometrical characteristics of the fore claw toes of mole rats Scaptochirus moschatus were analyzed. It was found that the middle three toes play the major role in soil-cutting performance. So the middle three toes were selected as the prototype for designing the biomimetic specimens. The biomimetic specimens were manufactured using reverse engineering and rapid prototype technology. The scales of the second toe (one of the middle three toes) and the angle between the back side and the palm side of the second toe were taken as the main geometrical structure parameters for designing the comparative specimen. The horizontal soil-cutting tests were conducted to examine the effects of the biomimetic geometrical structure on the soil-cutting resistance. The results show that the resistance of the biomimetic specimen is 12.80% smaller than the comparative specimen, which indicates that the toe geometry has a significant effect on its soil-cutting performance. The investigation into the effect of toe arrangement suggests that the tip positions of the middle three toes in arc curve arrangement is helpful to reduce soil-cutting resistance.     

Fingertip reconstructions using partial-toe transfers

Fifty-six partial toes were transferred to reconstruct fingertip deficits. The transfers from the big toe mainly consisted of 3 trimmed big toetips, 3 vascularized nail grafts, 3 onychocutaneous flaps, 19 thin osteo-onychocutaneous flaps, and 2 hemipulp flaps. The transfers from the second toe mainly consisted of 8 trimmed second toetips, 5 reduced second toes, and 9 whole distal phalanges. The average values of postoperative sensory recovery of the osteo-onychocutaneous flaps including the vascularized nail grafts were 3.1 (Semmes-Weinstein test) and 6.3 mm (moving two-point discrimination) at 2.6 years after the transfer; those of the thin osteo-onychocutaneous flaps were 3.1 and 7.2 mm at 2.0 years after surgery; those of the trimmed big toe tip transfers were 3.61 and 6.5 mm at 1.8 years after surgery; and those of the trimmed second toetip transfers were 3.37 and 6.3 mm at 2.6 years after transfer. Those of the distal phalanx of the second toe were 3.41 and 7.9 mm at 1.2 years after surgery, and those of the reduced second toe were 3.2 and 6.7 mm at 10.6 months after surgery.     

A modification of the great-toe transfer for thumb reconstruction

A modification of the great-toe-to-thumb transfer is presented, which includes sculpting the transferred toe with removal of soft-tissue pulp and bone from the lateral side of the toe. This modification provides the aesthetic advantages of the wrap-around flap while avoiding problems of bone graft resorption, pulp mobility, and a very difficult dissection. Function in our three patients has been excellent.     

Sixty-four cases of thumb and finger reconstruction using transplantation of the big toe skin-nail flap combined with the second toe or the second and third toes

The purpose of this article is to introduce the results of thumb and finger reconstruction using transplantation of the big toe wraparound flap combined with the second toe or the second and third toes. Between August of 1981 and December of 1998, in a series of 64 cases involving 58 patients with digitless hands, either (1) the thumb and index fingers were reconstructed by transplantation of a big toe wraparound flap combined with the adjacent second toe harvested from the ipsilateral foot; or (2) the thumb, index, and long fingers were reconstructed by transplantation of an ipsilateral big toe wraparound flap combined with the adjacent second and third toes. The phalanx of the new thumb was usually an iliac block. The success rate of this series was 92.2 percent. At long-term follow-up, the average static 2-point discrimination was less than 10 mm. The distance between the tip of the new thumb and the new index finger ranged from 6 to 10 cm (average, 8 cm). Opposition action was nimble and forceful. The patients could lift a 6- to 12-kg weight with their reconstructed digits. All patients were satisfied with their new hands and were able to use them in their daily activities. The transplants for reconstructing the thumb and fingers are harvested from the same foot in a procedure known as one-foot donation. Function of the bilateral digitless hand can be recovered with this procedure.     

Free tongue composite graft for correction of a vermilion defect

A case report of hemangioma of the vermilion border treated with excision and free composite tongue graft is presented. A technique of lip reconstruction utilizing a composite tongue graft in one step has been described. It constitutes an improvement over the tongue pedicle flap technique, which has been hitherto used and requires two stages. The indications and limitations of the technique have been discussed.     

Neural mechanisms of absolute tactile localization in monkeys

Macaca nemestrina monkeys were trained to indicate the location of suprathreshold tactile stimuli delivered to the glabrous skin of either foot. The testing paradigm involved self-initiated trials (a bar press), followed by 10-Hz stimulation at one of six locations (e.g., on the distal phalanx of the second toe on the left foot), providing the opportunity for the animal to press one of six buttons located on a facing panel. The buttons were positioned on a picture of a monkey's feet at locations corresponding to the skin loci that were stimulated on different trials. If the animal first pressed the button corresponding to the position stimulated, liquid reward was delivered; responses to any other button terminated stimulation without reward, requiring initiation of another trial for the opportunity to receive reinforcement. The localization errors for normal monkeys were reliably greater along the mediolateral dimension of the foot than they were proximodistally. For example, stimulation of the tip of toe 4 elicited responses to the button at the tip of toe 2 on 25% of the trials, as compared with only 10% errors between the tip of toe 4 and the pad at the base of toe 4. Following unilateral interruption of the dorsal spinal columns at an upper thoracic level, the capacity for absolute tactile localization was unchanged over months of testing. The greater localization accuracy along the proximodistal axis of the foot remained after dorsal column transection. In order to evaluate neural substrates of localization by monkeys, single-neuron receptive field (RF) sizes and distributions within the first somatosensory (SI) cortex were examined to determine the overlap or separation of the representations of different points on glabrous skin. The sample of neurons that provided the RF data was obtained in previous investigations of unanesthetized, neuromuscularly blocked Macaca fascicularis monkeys. Analysis of RF overlap revealed that greater than 50% of cytoarchitectural area 1 units that responded to stimulation of one digit tip also responded to another digit or to the pad at the base of a digit. These large RFs seem poorly suited to subserve a high degree of spatial localization and are compatible with the frequent localization errors by the monkeys in the behavioral experiments. However, the area 1 RF data do not explain the tendency of these animals to exhibit better localization accuracy along the proximodistal axis than along the mediolateral axis of the volar foot.(ABSTRACT TRUNCATED AT 250 WORDS)     

Toe‐bud clipping of juvenile small marsupials for ecological field research: No detectable negative effects on growth or survival

Toe clipping is widely used to permanently mark many species of small vertebrates including marsupials, particularly didelphids and dasyurids. Small marsupials are marked as juveniles, by removing the tip of developing toe buds. It has recently been shown that survival and/or recapture probability decreases with increasing number of toes clipped in frogs. Because of this and other animal welfare concerns, toe clipping of adult vertebrates is increasingly being discouraged. The short‐ and long‐term effects of toe‐bud clipping have not been evaluated in marsupials. We used an experiment to test if marking more toes results in slower growth or higher mortality in the brown antechinus (Antechinus stuartii, Dasyuridae) in the short or long term. We found no harmful effects of toe‐bud clipping. There were no infections associated with clipping, marking more toes did not reduce growth in young or adults, and did not affect survival of young in captivity, survival of independent animals in the wild, or recapture probability. Toe‐bud clipping is done at an extremely immature stage, when the area cut is tiny and perception and memory of pain is unlikely to be a problem. We suggest that toe‐bud clipping is a humane and benign method of permanently marking antechinuses, and probably also the young of other morphologically similar small marsupials.     

Neural Mechanisms of Absolute Tactile Localization in Monkeys

Macaca nemestrina monkeys were trained to indicate the location of suprathreshold tactile stimuli delivered to the glabrous skin of either foot. The testing paradigm involved self-initiated trials (a bar press), followed by 10-Hz stimulation at one of six locations (e.g., on the distal phalanx of the second toe on the left foot), providing the opportunity for the animal to press one of six buttons located on a facing panel. The buttons were positioned on a picture of a monkey's feet at locations corresponding to the skin loci that were stimulated on different trials. If the animal first presed the button corresponding to the position stimulated, liquid reward was delivered; responses to any other button terminated stimulation without reward, requiring initiation of another trial for the opportunity to receive reinforcement.

The localization errors for normal monkeys were reliably greater along the mediolateral dimension of the foot than they were proximodistally. For example, stimulation of the tip of toe 4 elicited responses to the button at the tip of toe 2 on 25% of the trials, as compared with only 10% errors betweeen the tip of toe 4 and the pad at the base of toe 4. Following unilateral interruption of the dorsal spinal columns at an upper thoracic level, the capacity for absolute tactile localization was unchanged over months of testing. The greater localization accuracy along the proximodistal axis of the foot remained after dorsal column transection.

In order to evaluate neural substrates of localization by monkeys, single-neuron receptive field (RF) sizes and distributions within the first somatosensory (SI) cortex were examined to determine the overlap or separation of the representations of different points on glabrous skin. The sample of neurons that provided the RF data was obtained in previous investigations of unanesthetized, neuromuscularly blocked Macaca fascicularis monkeys. Analysis of RF overlap revealed that greater than 50% of cytoarchitectural area 1 units that responded to stimulation of one digit tip also responded to another digit or to the pad at the base of a digit. These large RFs seem poorly suited to subserve a high degree of spatial localization and are compatible with the frequent localization errors by the monkeys in the behavioral experiments. However, the area 1 RF data do not explain the tendency of these animals to exhibit better localization accuracy along the proximodistal axis than along the mediolateral axis of the volar foot. We suggest that the observed asymmetry of localization accuracy may be the result of dynamic neural mechanisms that involve lateral interactions between cortical columns. Evidence from metabolic mapping experiments suggests that these lateral interactions determine the spatial distribution of cortical columns that respond to repetitive somatic stimuli (Whitsel et al, 1988).     

A New Surgical Technique for Polysyndactyly of the Toes without Skin Graft

Reconstruction for polysyndactyly of the toes aims at cosmetic improvement. A previous method that uses a skin graft has inherent disadvantages of mismatched pigmentation between the graft and the surrounding skin and scar formation at the donor site. The authors' new improved surgical technique for the treatment of polysyndactyly of the toes does not require a skin graft and therefore avoids these problems. The authors designed a subcutaneous flap from the distal portion of a rectangular flap of skin from the dorsal side of the interdigital webbing and moved the former flap to the sidewall of the base of a toe. Both flaps are the same size; therefore, an interdigital space had to be of sufficient size to accommodate both of them. To ensure an adequate blood supply to the flap, careful handling of the subcutaneous flap is essential for success. This procedure can apply to polysyndactyly of the fourth, fifth, and sixth toes when the fourth and fifth toes adhere over the distal side of the distal interphalangeal joint and when the skin on the dorsal side of the fifth toe, regarded as the excessive one, is at lease twice the size of the dorsal rectangular flap. Ten patients with polysyndactyly of the toe were treated with this method. Aesthetically good results were obtained.     

Combined second and third toe transfer

Historically, restoration of hand function following multiple digital amputation has been unsatisfactory. The evolution of digital reconstruction with toe transfer has enabled surgeons to reestablish prehension in these severely injured hands. A 4-year experience with 26 consecutive combined second and third toe transfers to replace missing adjacent fingers was reviewed in order to delineate the indications and technical considerations and to emphasize prevention of donor-site complications. Combined second and third toe transfer is reserved for adjacent finger amputations proximal to the digital web space with remaining fingers no longer than the small finger. Radial amputations are replaced with contralateral combined toe units, while ipsilateral toes are more ideal for ulnar amputations. Limited dorsal and plantar skin flaps extending only to the midpoint of the first and third digital web spaces allow for direct donor-site closure and uncomplicated healing. Maintenance of the plantar metatarsal arch by avoiding metatarsal shaft osteotomies or bone grafting-shortened metatarsals eliminates potential gait disturbances. When properly applied in selected patients, this single-stage microsurgical procedure can restore prehensile function, improve the appearance of the hand with multiple digital amputations, and preserve near-normal donor-foot function.     

The role of the columellar strut in rhinoplasty: indications and rationale

There are a variety of techniques that can be used to enhance or improve the nasal tip. These techniques often use suture techniques and invisible grafts to achieve the desired result. The former methods have been well described throughout the literature. Among the latter techniques, the columellar strut remains a popular and effective form of an invisible graft in rhinoplasty. The purpose of this article is to define the role of the columellar strut graft, describe how to perform it correctly in rhinoplasty, provide a clinical algorithm for its application, and detail a 15-year retrospective analysis of the senior author's (R.J.R.) experience. Previous references to the importance of the columellar strut graft in rhinoplasty have been described; however, none has formally defined its singular importance in both primary and secondary open rhinoplasty. This article details the role of the columellar strut and its relationship to nasal tip projection and lower lateral cartilage symmetry with an explanation of methods for improving each. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.     

Replantation of fingertip amputation by using the pocket principle in adults

There are several treatment modalities for zone 1 or zone 2 fingertip amputations that cannot be replanted by using microsurgical techniques, such as delayed secondary healing, stump revision, skin graft, local flaps, distant flaps, and composite graft. Among these, composite graft of the amputated digit tip is the only possible means of achieving a full-length digit with a normal nail complex. The pocket principle can provide an extra blood supply for survival of the composite graft of the amputated finger by enlarging the area of vascular contact. The surgery was performed in two stages. The amputated digit was debrided, deepithelialized, and reattached to the proximal stump. The reattached finger was inserted into the abdominal pocket. About 3 weeks later, the finger was removed from the pocket and covered with a skin graft. We have consecutively replanted 29 fingers in 25 adult patients with fingertip amputations by using the pocket principle. All were complete amputations with crushing or avulsion injuries. Average age was 33.64 years, and men were predominant. The right hand, the dominant one, was more frequently injured, with the middle finger being the most commonly injured. Of the 29 fingers, 16 (55.2 percent) survived completely and 10 (34.5 percent) had partial necrosis less than one-quarter of the length of the amputated part. The results of the above 26 fingers were satisfactory from both functional and cosmetic aspects. Twenty of the 29 fingers, which had been followed up for more than 6 months (an average of 16 months), were included in a sensory evaluation. Fifteen of these 20 fingers (75 percent) were classified as "good" (static two-point discrimination of less than 8 mm and normal use). From the overall results and our experience, we suggest that the pocket principle is a safe and valuable method in replantation of zone 1 or zone 2 fingertip amputation, an alternative to microvascular replantation, even in adults.     

甜樱桃新品系13-38茎尖无性系建立及试管苗嫁接研究

本文报告通过茎尖培养及试管苗嫁接快速繁殖甜樱桃新品系13—38苗木。取新品系母树休眠芽制备成无菌外植体,分别在MS附加6-BA 0.1-0.5mg／L,IAA 0.1mg／L培养基及MS附加ZTl-1.5 mg／L,IAA 0.1-0.25 mg／L培养基中进行微型扦插及茎尖分化培养,建立茎尖无性系。试管苗年扩繁量为48和108。以新品系试管苗为接穗,采用切接,皮接两种方法嫁接于四种砧木,成活率为20一70%不等。实验表明13—88试管苗与砧木新品系1090试管幼苗的亲和力较好。接合部位预先施用200ppm的NAA可提高嫁接成活率。     

Five long-term case reports (average 15 years) of saddlenose correction using cast Silastic implants

A 15-year review of patients who underwent silicone implants to the nasal bridge was conducted. None of my implants had to be removed because of either hematomas or infection. To my knowledge, only one implant has been removed for any reason over the last 10 years. Another nasal implant was removed by a surgeon in New Orleans and was replaced by a rib cartilaginous graft, which, within 2 years, severely curled, causing a nonacceptable result. This cartilage graft was removed and replaced with a second silicone implant and, to my knowledge, was still satisfactory and in place 10 years postoperatively. Insertion of implants with lateral nasal bone infracturing and submucous resection, along with tip reduction, is now performed in almost all patients. Tip elevation, when necessary, is accomplished by rotation of the nasal floor and columella up the maxillary spine (and septal cartilage) to obtain a maximum of 6 mm of elevation, some of which is lost following subsidence of swelling and/or dissolution of the suture material.     

A modified Goldman nasal tip procedure for the drooping nasal tip

A modification of Irving Goldman's nasal tip procedure that borrows from the lateral crus to augment the height of the medial crus is described. Goldman's procedure has been modified by not including the vestibular skin with the segment of the lateral crus that is rolled medially to increase nasal tip projection, by adding a nasal septal cartilage strut between the medial crura for support when the medial crura are weak, and by maintaining a small separation caudally of the repositioned lateral crura at the new nasal dome to simulate a double nasal dome. This modified Goldman nasal tip procedure allows the surgeon to reshape the lower lateral nasal cartilage to increase nasal tip projection as an alternative to the use of a shield-type nasal tip graft, and at the same time it narrows the nasal tip with minimal resection of the lateral crus of the lower lateral nasal cartilage.     

Effects of ramp negotiation, paving type and shoe sole geometry on toe clearance in young adults

Trips are a major cause of falls and result from involuntary contact of the foot with the ground during the swing phase of gait. Adequate toe clearance during swing is therefore crucial for safe locomotion. To date, little is known about the effects of environmental factors and footwear on toe clearance. This study reports on modulation of toe clearance and toe clearance variability in response to changes in ground inclination, paving type, and shoe sole geometry. Toe clearance and toe clearance variability for ten healthy young adults were calculated two-fold: a) for the commonly-used position on the foremost part of the sole of the shoe and b) for the lowest of a total of 7 sole positions, located between the metatarsals and the toe tip across the entire width of the sole. Utilizing a full-factorial design we found that toe clearance was affected by ground inclination, paving type, and sole geometry regardless of the computational method used (with p-values<0.01) but the use of the foremost part of the sole for toe clearance calculation results is an overestimation of this value. Our findings highlight the importance of considering footwear and environmental factors when assessing the risk of tripping. Future work needs to investigate to which extent the same factors affect toe clearance in more vulnerable parts of the population.     

Lengthening the foreshortened nose

The surgically shortened nose is an infrequent but distressing problem that is difficult to repair. This article describes a simple technique to lengthen the nasal profile with a triple-stacked tip graft placed caudal to the medial crura. Fifteen patients have been operated on, and most were undergoing face lifts. The skin inelasticity in older patients allows easy skin redraping over the larger tip volume.     

Fgf signaling controls the number of phalanges and tip formation in developing digits

Tetrapods have two pairs of limbs, each typically with five digits, each of which has a defined number of phalanges derived from an archetypal formula. Much progress has been made in understanding vertebrate limb initiation and the patterning processes that determine digit number in developing limb buds, but little is known about how phalange number is controlled. We and others previously showed that an additional phalange can be induced in a chick toe if sonic hedgehog protein is applied in between developing digit primordia. Here we show that formation of an additional phalange is associated with prolonged Fgf8 expression in the overlying apical ridge and that an Fgf Receptor inhibitor blocks its formation. The additional phalange is produced by elongation and segmentation of the penultimate phalange, suggesting that the digit tip forms when Fgf signaling ceases by a special mechanism, possibly involving Wnt signaling. Consistent with this, Fgfs inhibit tip formation whereas attenuation of Fgf signaling induces tip formation prematurely. We propose that duration of Fgf signaling from the ridge, responsible for elongation of digit primordia, coupled with a characteristic periodicity of joint formation, generates the appropriate number of phalanges in each digit. We also propose that the process that generates the digit tips is independent of that which generates more proximal phalanges. This has implications for understanding human limb congenital malformations and evolution of digit diversity.     

Prefabrication of composite free flaps through staged microvascular transfer: an experimental and clinical study

The feasibility of prefabricating free flaps by inducing, through the process of staged reconstruction, an arteriovenous bundle and its surrounding fascia to perfuse a selected block of tissue was investigated experimentally and clinically. Sixteen rat knee joints were wrapped with their ipsilateral superficial inferior epigastric (SIE) fascia. In 8 joints, the composite flaps were resected en bloc and were immediately replaced orthotopically pedicled upon the superficial inferior epigastric vessels. In the remaining joints, the resection and orthotopic transfer were performed 2 weeks later. Only the joints in the latter group, which benefited from the staging period, were found to be perfused. The long finger proximal interphalangeal joint of a child was reconstructed by the staged microvascular transfer of his second toe proximal interphalangeal joint. At the first stage, a temporalis fascia flap was wrapped around the toe proximal interphalangeal joint and revascularized to the dorsalis pedis vessels. Six weeks later, the joint and its temporalis fascia envelope were dissected, and the "prefabricated" joint flap was transferred to the hand and revascularized to the wrist vessels. Bony union progressed uneventfully with excellent recovery of the range of motion. We conclude that regardless of the indigenous vascular anatomy, an unlimited array of composite free flaps can be constructed and transferred based on induced large vascular pedicles.