Toe and plantar dermatoglyphics in adult American Caucasians

The scarcity of information on control data of toe and plantar dermatoglyphics led us to undertake this study of adult American Caucasians. Toe and sole prints of 168 male and 83 female participants of the Baltimore Longitudinal Study of Aging were analyzed. Toe pattern frequencies demonstrate that fibular loops are the most prevalent pattern on the toes in both males and females. Pattern distribution by digit shows that arches are most often located on the fifth toe while whorls are found with greatest frequency on the third toe. Plantar pattern frequencies indicate that the most common pattern found in the hallucal area is the distal loop. Open fields are frequently found in the II and IV interdigital areas while distal loops are prevalent in the III area. These results are compared to the finger and palmar patterns of the same individuals. The distribution of patterns on the toes and fingers of the same individuals appear to be quite different. Population comparisons did not demonstrate a clear racial difference in the toe pattern frequencies or in the plantar areas.     

Finite-element simulation of flexor digitorum longus or flexor digitorum brevis tendon transfer for the treatment of claw toe deformity

Claw toe deformity sometimes leads to dorsiflexion of the metatarsophalangeal joint (MPJ) and plantar flexion of the proximal (PIPJ) and distal interphalangeal (DIPJ) joints. Flexor digitorum longus tendon transfer (FDL) is currently the gold standard for the correction of this problem. Transfer of the flexor digitorum brevis (FDB) has been recently proposed as an alternative method to treat such deformity. The aim of this work is to compare the biomechanical outcome of these two methods by means of finite-element simulation. The results show that the reduction in the dorsal displacement of the proximal phalanx (PP) for the second and third toes were very similar (about 4.3 mm for each intervention), both achieving a significant reduction in MPJ dorsiflexion when compared to no intervention (displacements are reduced by approximately 51%). In the fourth and fifth toes, only a small correction in the deformity was achieved with both the techniques (10% and 7%, respectively). FDB and FDL tendon transfer reduced the stress level when compared with the non-operated pathologic foot (the reduction of stresses for the second and third PP ranged between 20% and 40%). FDB transfer resulted in a more uniform distribution of stress along the entire toe, although differences were small in all cases. These results confirm that both the tendon-transfer techniques are effective in the treatment of claw toe deformity. Therefore, the choice of technique is at the discretion of the surgeon.     

Pedal symphalangism in modern American and Japanese skeletons

Pedal symphalangism is a surprisingly common heritable trait of the human foot. In individuals exhibiting the trait, the joint between the intermediate and distal phalanges of one or more lateral toes never develops, resulting in toes with two phalanges rather than three. This study was undertaken to explore variation in the frequency of pedal symphalangism among groups with widely different geographic ancestry, and to consider the applicability of this trait to skeletal biological distance studies. A total of 460 Euro-American, 191 African-American and 99 Japanese skeletons were examined for presence of pedal symphalangism. The American individuals date to the first half of the 20th c, while the Japanese individuals date to the late 19th and early 20th c. Although the country of ancestry is unknown for most of the American individuals, the Euro-Americans appear to be largely northern European, with roots in Germany, Ireland and Scandinavia, while the African-Americans are primarily descendants of slaves with roots in west African countries such as Nigeria, Benin, Togo, Ghana and Sierra Leone. Frequencies of fifth toe pedal symphalangism were calculated and compared among all three samples and found to be significantly higher in modern Japanese (83.7%) than in either Euro-Americans (46.4%) or African-Americans (44.0%). The Euro- and African-American frequencies were statistically indistinguishable for symphalangism of the fifth toe. In the fourth toe, however, the opposite result was found. The African-American frequency (7.9%) was significantly higher than the Euro-American frequency (2.6%), while no difference was found between the African-Americans and Japanese (11.7%). Since fourth toe pedal symphalangism has never been observed in the absence of fifth toe involvement, some of the same genes are clearly involved in producing the trait in both toes. However, differences in the pattern of fourth and fifth toe expression among the three groups identified in this study suggest that additional genetic or developmental factors may play a role in expression of pedal symphalangism in each of the toes.     

Surgical method for treatment of syndactyly with osseous fusion of the distal phalanges.

For the interdigital space plasty to correct a syndactyly with fusion of the distal phalanges, we adopted a new operative procedure, covering the exposed distal bone with local rectangular flaps designed transversely on both dorsal and volar surfaces. A full-thickness skin graft from the groin region covers the remaining raw surface. The procedure was performed in six patients, and the flaps measured 6 mm (width) x 12 to 16 mm (length) in four patients, 5 x 15 mm in one patient, and 5 x 18 mm in one patient. Partial necrosis was observed in only one patient, in whom a narrow flap of 5 x 18 mm was used. In the other five patients, however, the results were satisfactory on both external appearance and function during the follow-up period of 3 to 6 years.     

The critical relationship between free radicals and degrees of ischemia: evidence for tissue intolerance of marginal perfusion

Skin-flap ischemia has been associated with the presence of free radicals. In this study, two enzyme systems involved in free-radical metabolism were used to compare a distal skin flap to a skin graft. Forty-two rats were divided into several test groups. A 10 X 3 cm dorsal rat flap was used, and tissue biopsies for xanthine oxidase and malonyldialdehyde (MDA) were obtained 2.5, 5.5, and 8.5 cm from the base of the flap at the hours given. In group I (control), the flap was outlined but not elevated, and biopsies were obtained. In group II, the flap was elevated, and biopsies were obtained at 6 hours. In group III, the flap was elevated, the distal 4 X 3 cm was amputated and replaced as a full-thickness skin graft, and biopsies were obtained at 6 hours. In group IV, the flap was elevated, and biopsies were obtained at 12 hours. In group V, the flap was treated as in group III, and biopsies were obtained at 12 hours. In group VI, the flap was elevated, and biopsies were obtained at 24 hours. In group VII, the flap was treated as in group III, and biopsies were obtained at 24 hours. Results: Xanthine oxidase was significantly higher in all distal biopsies compared to proximal biopsies. Xanthine oxidase also increased with time. Malonyldialdehyde increased over time as well as with distance from the flap base. Distal flap biopsies at 24 hours had greatly increased levels of malonyldialdehyde compared to skin grafts (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Congenital curved nail of the fourth toe

Five cases of congenital curved nail of the fourth toe are reported. Patients included four males and one female; four cases were bilateral, and one was unilateral. There were no other significant associated anomalies of the extremities, and only the fourth toes were affected. The features of the deformity are a curved nail and hypoplasia of the soft tissue and bone of the distal phalanx of the fourth toe. This anomaly may be transmitted autosomally and is unique in that it may be of mesodermic origin.     

The boomerang flap in managing injuries of the dorsum of the distal phalanx

Finding an appropriate soft-tissue grafting material to close a wound located over the dorsum of a finger, especially the distal phalanx, can be a difficult task. The boomerang flap mobilized from the dorsum of the proximal phalanx of an adjacent digit can be useful when applied as an island pedicle skin flap. The vascular supply to the skin flap is derived from the retrograde perfusion of the dorsal digital artery. Mobilization and lengthening of the vascular pedicle are achieved by dividing the distal end of the dorsal metacarpal artery at the bifurcation and incorporating two adjacent dorsal digital arteries into one. The boomerang flap was used in seven individuals with injuries involving the dorsal aspect of the distal phalanx over the past year. Skin defects in all patients were combined with bone,joint, or tendon exposure. The authors found that the flap was reliable and technically simple to design and execute. This one-step procedure preserves the proper palmar digital artery to the fingertip and has proven valuable for the coverage of wide and distal defects because it has the advantages of an extended skin paddle and a lengthened vascular pedicle. When conventional local flaps are inadequate, the boomerang flap should be considered for its reliability and low associated morbidity.     

Distally based dorsal forearm fasciosubcutaneous flap

Use of a local flap is often required for the reconstruction of a skin defect on the dorsum of the hand. For this purpose, a distally based dorsal forearm fasciosubcutaneous flap based on the perforators of the posterior interosseous artery was developed. From 1997 until 2002, this flap was used to reconstruct skin defects on the dorsum of the hand in nine patients at Chonnam National University Medical School. The sizes of these flaps ranged from 10 to 14 cm in length and from 5 to 7 cm in width. The flaps survived in all patients. Marginal loss over the distal edge of the flap was noted in one patient. Three flaps that developed minimal skin-graft loss were treated successfully with a subsequent split-thickness skin graft. The long-term follow-up showed good flap durability and elasticity. The distally based dorsal forearm fasciosubcutaneous flap is a convenient and reliable alternative for reconstructing skin defects of the dorsum of the hand involving vital structure exposure. It obviates the need for more complicated and time-consuming procedures.     

Measurement of skin blood flow in delayed deltopectoral flaps, using local clearance of 133Xenon.

A study was made to determine the skin blood flow at the deltoid region in 89 cases, and the regional blood flow of delayed deltopectoral flaps, using the local clearance of 133Xe. The change in the skin blood flow, before and after a delay procedure of the deltopectoral flap, was measured in 27 patients--and the following results were obtained. (1) There was a linear tendency to a decreasing flow, one found to be statistically significant, with increasing age of the patient. (2) A significant correlation was found between the skin blood flow and the blood flow of the subcutaneous tissue. (3) The blood flow after we raised one side of a deltopectoral flap and lined it with a split-skin graft was higher than that found after a U-shaped undermining and not lining a flap. (4) The rate of successful transfer of a deltopectoral flap was found to be low when the 133Xe clearance rate was less than 0.07.     

The dorsal reverse adipofascial flap for fingertip reconstruction

Nine patients who presented with fingertip amputations were treated with the dorsal reverse adipofascial flap. The mean age of the patients was 41.3 years and the mean follow-up was 18 months. The flap described here was used only for amputations at the level of the nail fold, from approximately the lunula to the proximal nail matrix. This flap is based on the dorsal arterial branches that originate from the volar digital arteries just distal to the distal interphalangeal joint. The flap uses only the adipofascial tissue over the middle phalanx of the injured finger; it is turned over to cover the fingertip defect and then covered with a split-thickness skin graft. All flaps survived completely, and the patients continue to use their fingertips as before the amputation injury. This one-step operation is easily performed (even in the emergency department), makes no use of the adjacent digits, and provides a pleasing and stable cover for the fingertips.     

Neuromucosal prelaminated flaps for reconstruction of intraoral lining defects after radical tumor resection

To reconstruct intraoral lining defects after radical tumor resection by reinnervated vascularized mucosa, eight distal radial forearm flaps and two fibula flaps were prelaminated. Prelamination was performed by exposing the vascularized fascia, onto which the split distal end of a sural graft was fixed. The fascia and the sural nerve graft were covered by device-meshed mucosa or small full-thickness mucosa pieces. These structures again were covered by a Silastic sheet as large as the future flap, and the wound was closed by the elevated skin and subcutaneous tissue. Coverage by a Silastic sheet enabled mucosal spreading on the fascia, and the final flaps were thin, mucus-producing, and larger than the originally inserted mucosa. The 10 neuromucosal prelaminated flaps were harvested together with the inserted sural nerve graft after 8 to 10 weeks. During this time, the patient underwent radiotherapy and chemotherapy. Donor sites were closed directly by the preserved skin and subcutaneous tissue. Intraoral defects were reconstructed successfully by eight neuromucosal prelaminated distal radial forearm flaps and two neuromucosal prelaminated fibula flaps. The sural nerve grafts, inserted between the fascia and the mucosa, were coaptated eight times with the lingual nerve and two times with the inferior alveolar nerve. Intended reinnervation of the mucosa could already be proved clinically and histologically in the first two patients after 11 and 9 months. Preservation of skin and subcutaneous tissue considerably lowered donor-site morbidity. Neuromucosal prelamination enables reconstruction of intraoral lining defects by reinnervated mucus-producing tissue. Reconstruction of other mucosa-lined structures by this method seems feasible. Avoidance of skin islands for reconstruction lowers donor-site morbidity.     

The cutaneous microbiology of normal human feet

A survey has been made of the bacterial and fungal populations carried at three different sites on the feet of 60 individuals. The bacteria found at the three sites were quantitatively similar and Micrococcaceae and aerobic coryneform bacteria predominated. The carriage of other bacterial groups was generally low. There was a quantitative variation between sites--mean total counts were 1.04 X 10(7) cfu/cm2 skin in the fourth toe cleft, 4.08 X 10(5) cfu/cm2 skin on the sole and 1.21 X 10(3) cfu/cm2 skin on the dorsal surface. Staphylococci were most often dominant on the sole and dorsal surface whereas aerobic coryneforms predominated in the majority of fourth toe clefts. The higher the total count at a given site the more likely it was that aerobic coryneform bacteria predominated. The skin surface pH was significantly higher on the sole (mean value 6.25) than on the dorsal surface (mean value 5.23). Factors controlling the microbial ecology of the foot are discussed.     

The skin of birds' feet: Morphological adaptations of the plantar surface

The skin of the foot provides the interface between the bird and the substrate. The foot morphology involves the bone shape and the integument that is in contact with the substrate. The podotheca is a layer of keratinized epidermis forming scales that extends from the tarsometatarsus to the toe extremities. It varies in size, shape, amount of overlap and interacts with the degree of fusion of the toes (syndactyly). A study of toe shape and the podotheca provides insights on the adaptations of perching birds. Our analysis is based on micro‐CT scans and scanning electron microscopy images of 21 species from 17 families, and includes examples with different orientations of the toes: zygodactyl (toes II and III forward), anisodactyl (toes II, III, and IV forward), and heterodactyl (toes III and IV forward). We show that in these three groups, the skin forms part of a perching adaptation that involves syndactyly to different degrees. However, syndactyly does not occur in Psittacidae that use their toes also for food manipulation. The syndactyly increases the sole surface and may reinforce adherence with the substrate. Scale shape and toe orientation are involved in functional adaptations to perch. Thus, both bone and skin features combine to form a pincer‐like foot.     

Osteocutaneous flap prefabrication in rats

Composite tissue defects may involve skin, mucosa, muscle, and bone together or in combinations of two or three of these tissues. Defects involving bone and skin are frequently encountered. Osteocutaneous flaps may be used to reconstruct these composite tissue defects. Sometimes, it is not possible to obtain a vascular osteocutaneous flap. Another way of producing an osteocutaneous flap that has the desired feature is prefabrication. Prefabrication of osteocutaneous flaps can be performed in two ways: (1) a vascularized osseous flap may be grafted with skin and (2) an osteocutaneous flap can be prefabricated by implanting an osseous graft into an axial island flap. There are many articles describing osteocutaneous flap prefabrication, but there is no comparison of both methods in the literature. As an experimental model for osteocutaneous flap prefabrication, rat tail bone was chosen. For the experiments, five groups were formed. Each group contained 10 rats. In the first experimental group, a vascularized osseous segment was skin grafted and an osteocutaneous flap was prefabricated. In the second experimental group, an osseous graft was implanted into an axial skin flap. To compare viability of skin and bone components of the two prefabrication groups, vascularized tail bone was elevated with overlying skin in the third group, a bone flap was elevated in the fourth group, and a skin flap that had been prefabricated by using vascular implantation was elevated in the fifth group. The authors examined five rats in each group by microangiography at the end of 4 weeks. On microangiographic analysis, all groups showed patency of vascular pedicles. There was no difference among the groups from the point of view of vascular patency and bone appearance. Bone scintigraphy was performed on the five rats in each group. On bone scintigraphic scans, the bone component of flaps was visualized in all groups except for group 5. The mean radioactivity value on the flap side was 10,362 +/- 541.1 in group 1, 10,241 +/- 1173 in group 2, 10,696 +/- 647.1 in group 3, and 10,696 +/- 647.1 in group 4. When the radioactivity values on the flap side were compared, no statistically significant difference among groups was seen, except for group 5 (p < 0.05). To evaluate bone metabolic activity, the bone component of flap and remaining last tail bone was harvested and the radioactivity of each specimen was measured with a well-type gamma counter. The parameter of percentage radioactivity in counts per minute per unit per gram of tissue was calculated. The value of the bone component of the flap side and the value of normal bone were estimated and results were compared. The mean result was 0.86 +/- 0.08 in group 1, 0.88 +/- 0.07 in group 2, 0.87 +/- 0.07 in group 3, and 0.81 +/- 0.04 in group 4. The difference among all groups was not statistically significant. Histologic examination was performed on all rats in each group and demonstrated that the bony component was viable, showing a cellular bone marrow, osteoblasts along bony trabeculae, and vascular channels in bone-containing groups. There were no significant microangiographic, histologic, or scintigraphic differences between the two experimental methods.     

Peroneal flap for reconstruction in the extremity: preliminary report

The peroneal flap has many advantages, such as thin subcutaneous tissue, availability of a large-diameter artery and vein for anastomosis, a long pedicle, and freely designed size and shape. This technique is introduced because it has many outstanding features that allow it to be used to meet a variety of specific needs, such as a free peroneal flap, a peroneal island flap, a free vascularized fibular graft with skin, and a monitoring flap in free vascularized fibular grafts. We have found the peroneal flap to be especially useful.     

Influence of continuous challenge via the feed on competitive exclusion of salmonellas from broiler chicks

A survey has been made of the bacterial and fungal populations carried at three different sites on the feet of 60 individuals. The bacteria found at the three sites were quantitatively similar and Micrococcaceae and aerobic coryneform bacteria predominated. The carriage of other bacterial groups was generally low. There was a quantitative variation between sites—mean total counts were 1.04 ± 10⁷ cfu/cm² skin in the fourth toe cleft, 4.08 ± 10⁵ cfu/cm² skin on the sole and 1.21 ± 10³ cfu/cm² skin on the dorsal surface. Staphylococci were most often dominant on the sole and dorsal surface whereas aerobic coryneforms predominated in the majority of fourth toe clefts. The higher the total count at a given site the more likely it was that aerobic coryneform bacteria predominated. The skin surface pH was significantly higher on the sole (mean value 6.25) than on the dorsal surface (mean value 5.23). Factors controlling the microbial ecology of the foot are discussed.     

Posterior interosseous free flap with extended pedicle for hand reconstruction

The anatomy of the posterior interosseous vessels makes them suitable as a donor area of free flap. The skin island can be designed on the perforating vessels of the distal third of the forearm, up to the dorsal wrist crease, to increase the pedicle length (7 to 9 cm). A series of nine flaps transferred to reconstruct hand defects is presented. All flaps were designed over the dorsal distal forearm, and dimensions permitted direct closure of the donor site (up to 4 to 5 cm wide). Apart from a linear scar, donor morbidity was negligible. All transfers were successful. Although its dissection is somewhat tedious, the anatomy of the vascular pedicle is suitable for microanastomosis and the skin island is thin, although hairy. The posterior interosseous free flap with extended pedicle may be a good choice when limited amounts of thin skin and a long vascular pedicle are needed.     

Correction of first web space deficiency in congenital deformities of the hand with the pseudokite flap

The authors describe a new flap to enlarge or create a first web in patients with congenital deficiencies of the hand. This lozenge-shaped flap is harvested from the dorsoradial aspect of the index finger based on a narrow proximal skin bridge protecting its axial vascularization. A dorsal skin graft of the donor site is avoided by closure using a rhomboid flap. Procedures in 16 patients were performed and reviewed; the only complication was insertion of a small split-thickness graft in five patients to avoid tension at the metacarpophalangeal joint level. The flap lengthened the web fold an average of 3.2 cm without "pseudolengthening" the thumb.     

The sandwich temporoparietal free fascial flap for tendon gliding.

Microsurgical transfer of the superficial and deep temporal fascia based on the superficial temporal vessels has been documented. This article analyzes the functional recovery when each layer of this facial flap is placed on either side of reconstructed or repaired tendons, to recreate a gliding environment. This fascial flap also provided a thin, pliable vascular cover in selected defects of the extremities.Six patients (four male and two female) with tendon loss and skin scarring of the hand (three dorsum, one palmar, and one distal forearm) and posttraumatic scarring of the ankle with tendoachilles shortening (one patient) underwent this procedure. No flap loss was witnessed. Good overall functional recovery and tendon excursion were observed. Complication of partial graft loss was observed in two patients.     

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.