Vascularized second toe transfer is a useful surgical method for finger loss. The purpose of this paper is to report the clinical results of vascularized second toe transfer for traumatic distal finger loss. A retrospective case series of 10 digits belonging to 8 consecutive patients who underwent second toe transfer was conducted. The mean follow-up duration was 25 months. The number of injured fingers, waiting period for reconstruction, survival rate, and clinical outcomes, including the range of motion, grip strength, and return to work, were reviewed and analyzed. The severity of the injured hand was classified according to Piñal’s classification. The mean waiting period was 41 days. Ten toes were transferred and all toes survived. The mean final percentage of total active motion of the digits was 66.2% and the mean percentage of grip strength was 71.2% of the contralateral uninjured side. All injured hands were upgraded from the preoperative status by Piñal’s classification. Seven of 8 patients were able to return to their previous jobs. This study revealed that second toe transfer for distal finger loss is useful for functional recovery from severely injured hand and return to work.

  Venous anastomosis is an important component of distal replantation. However, if no veins are available, artery-only replantation is performed using an external bleeding method. The purpose of this study was to examine cases wherein fingertip replantation was performed without venous anastomosis at our hospital. This retrospective study included 53 consecutive patients（56 fingertips） who underwent fingertip replantation without venous anastomosis between 2006 and 2020. All patients underwent complete amputation distal to the distal interphalangeal joint（Ishikawa’s subzones I-IV）. The overall survival rate was 92.9%（52/56）. Survival was achieved in 100%, 95.8%, 100%, and 75.0% of those with subzone I, II, III, and IV amputations, respectively. Subzone IV was associated with a significantly lower rate. Single-digital arterial anastomosis was established in 50 digits, and two-artery anastomosis was established in 6. Interpositional venous grafts were used in 12 digits to reconstruct the digital artery. The numbers of arterial anastomoses and interpositional venous grafts were not correlated with the survival rate. The mean duration of external bleeding was 5.0 days. Six of 53 patients required blood transfusion. We concluded that subzones I to III are the limiting levels of artery-only replantation.

  ［Objective］Brachial plexus injury（BPI）associated with thoracic surgery is a rare complication. We report the clinical features of this condition, and investigated the cause and pathophysiology.
  ［Methods］Sixteen patients（mean age 67.0）with BPI following thoracic surgery were included in this study. Median sternotomy was performed for all patients. We investigated the type of palsy, clinical symptoms, factors leading to this condition, treatment, and prognosis.
  ［Results and conclusions］The type of palsy was lower type for all patients. Weakness of wrist extension and finger flexion in 12 patients, and slight motor disturbance in 4 patients developed after the operation. Hypesthesia at the level of C7/8 in all patients and burning sensation in 3 patients developed postoperatively. Thirteen patients had ipsilateral first rib fracture. All patients were treated conservatively. Motor disturbance recovered to MMT 5 in 10 patients and to MMT 4 in 5 patients within 6 months postoperatively. BPI was detected in 15 of 848 patients（1.8%）who underwent thoracic surgery with median sternotomy. We hypothesized that the lower brachial plexus was compressed between the first rib and clavicle due to excessive sternal retraction because ipsilateral first rib fracture was present in 13 of 16 patients（81.3%）.

  This report presents two cases of reconstruction after radical resection of arteriovenous malformation of the finger using a sensate free radial forearm flap transfer. 　
  In case 1, diffuse arteriovenous malformation of the middle finger was resected, leaving only bones and tendons, and reconstruction was performed using sensate free radial forearm flap transfer. One year after the operation, there has been no recurrence of the disease and sensory reconstruction was acceptable.　
  In case 2, diffuse arteriovenous malformation of the thumb was resected, leaving only bones and tendons, and reconstruction was performed using sensate free radial forearm flap transfer. Similarly, one year after the operation, there has been no recurrence of the disease and sensory reconstruction was acceptable.　
  In both cases, the functional result was acceptable and the aesthetic result was good. Based on this report, radical excision for arteriovenous malformation of the finger and reconstruction using sensate free radial forearm flap transfer will give good results.