There is no gold standard for the treatment of post-traumatic ankylosis of finger proximal interphalangeal ( PIP ) joints. We report the outcomes of vascularized 2nd-toe-PIP-joint transfers to the finger PIP joints. We performed a retrospective review of our patients who met the following criteria : ( 1 ) post-traumatic injuries of finger PIP joints with an arch of motion of no more than 10 degrees, ( 2 ) adult patients, ( 3 ) a PIP joint of the 2nd toe as a donor, and ( 4 ) more than one year of postoperative follow-up. A total of 7 joints of 7 male patients are included in this study. The mean age of the patients at the time of surgery was 26 years ( range : 16 to 42 ) and the mean postoperative follow-up period was 17 months ( range : 12 to 24 ). The mean postoperative active range of motion of the transferred joints was 71° ( range : 45 to 85 ) in flexion and −24° ( range : −50 to −10 ) in extension. No osteoarthritic change was found in any transplanted joint at the latest follow-up. Vascularized 2nd-toe-joint transfer is one of the optimal options for reconstruction of post-traumatic ankylosis of finger PIP joints in adult patients.
A tissue oximeter OXY-2® is a device that transmits two wavelengths of near-infrared rays to a depth of 10 mm just below the sensor and detects some of the reflected scattering light in order to measure the tissue oxygen saturation ( StO2 ). The greatest advantages of the tissue oximeter are that measurement of tissue oxygen saturation is possible at any site of the local living body such as the finger, as well as the trunk and the skin flap at which StO2 is not measurable with a conventional transmission-type pulse oximeter, and that consecutive measurements can be made non-invasively due to the lack of a need for an arterial pulse and use of detection of reflected scattering light. We performed continuous 7-day monitoring after operation for 16 samples of free skin flap with the use of the tissue oximeter. Although 1 case of arterial blockage and 1 case of venous blockage occurred, we were able to treat them with re-operation based on early diagnosis. It was suggested that skin flap monitoring with the tissue oximeter is useful for the early diagnosis of circulatory deficit after an operation.
We retrospectively assessed the utility of the LigaSureTM Vessel Sealing System compared with conventional surgery in 40 cases of free osseous flap harvest comprising 17 fibula flaps ( LigaSure : conventional, 11 : 6 ), 13 scapula flaps ( 4 : 9 ), and 10 iliac crest flaps ( 8 : 2 ). Postoperative duration of suction drain, total fluid collection volume by drain, and avascularized time during fibula flap harvest with a tourniquet did not differ significantly between the LigaSureTM and conventional techniques. In one case, additional surgery due to hematoma was required 23 days postoperatively in a donor site following scapular tip flap harvest without LigaSureTM. Reconstructive surgery with free flap transfer is performed with recipient surgery, such as tumor ablation or contracture release; therefore, intraoperative blood loss and total surgical time, which are reportedly significantly decreased by LigaSureTM, could not be evaluated in this study. LigaSureTM enables complete hemostasis to be easily accomplished, and the results of hemostasis are at least as favorable as those with the conventional technique.
Temporal depressive deformity is sometimes seen after neurosurgery. Various reports have described the correction of this temporal hollowing, but in most cases, artificial materials or non-vascularized autografts were used. However, these deformities are caused by atrophy or defect of temporal muscle and temporal fat pad, and these cases have already undergone operations, so the recipient condition is worse. Therefore, we prefer to use vascularized autografts. We describe three cases of temporal depressive deformity after neurosurgical reconstruction with an anterolateral thigh adipo-fascial flap tailored for each defect. The first two cases had complications with vascular difficulty. Reoperation was needed, and both flaps survived. However, in one case, the flap drooped at a follow-up of 2 months, so yet another operation was needed to replace volume. We examine the first two cases and conclude that this method requires certain techniques to fix the flap to bone and skin, and to decide on the size of the monitoring flap in the adipo-fascial flap in order to avoid vascular difficulty. In the third case, we operated while considering these points, which resulted in no difficulties being encountered. Although there were some complications, all cases finally achieved good cosmetic and functional results and all donor sites healed without complications.
We have experienced a case of successful bone union of intractable humerus neck fracture and remarkable improvement of lymphedema of the upper extremity with pedicled latissimus dorsi flap transfer. A 70-year-old man broke the right humerus at the surgical neck. He had suffered from malignant dermatitis on the right shoulder in his childhood and undergone radiation therapy, so the soft tissue around his right shoulder was severely damaged. He had lymphedema of the right upper extremity before the fracture. Bone union of the humerus neck fracture could not be achieved in the first operation with Ender nail fixation. In the second operation, fixation with an anatomical locking plate and soft tissue reconstruction with pedicled latissimus dorsi flap transfer were performed. Successful bone union was obtained and unexpectedly, the lymphedema of the upper extremity disappeared postoperatively. This might suggest that soft tissue reconstruction with pedicled latissimus dorsi flap transfer promotes the drainage of lymphedema of upper extremity.
True symphalangism is a rare anomaly of the hand. It is seldom indicated for surgical treatment, because the function of the proximal interphalangeal ( PIP ) joint, which is usually involved, is generally compensated for by hyperflexion of the adjacent distal interphalangeal ( DIP ) joint. We report a case of true symphalangism in a five-year-old boy, whose PIP and DIP joints were both ankylosed. The PIP joint of the affected fin-ger was reconstructed via a free vascularized toe-joint transfer. In the final follow-up evaluation at 15 months after the operation, 30° active motion was observed in the PIP joint. Radiographs demonstrated successful bone union and the growth plate remained open. No osteoarthritic changes were observed. The boy and his parents were satisfied with the surgical outcome, although the functional result was fair in terms of the range of motion. Thus, free vascularized toe-joint transfer is an effective method for true symphalangism, especially when the PIP and DIP joints are both ankylosed. However, the timing of the operation should be considered carefully to ensure adequate postoperative rehabilitation.