Motohisa Kawakatsu

Dorsal digital perforator flap for reconstruction of distal dorsal finger defects

Three patients are presented in whom defects of the distal part of the dorsum of the finger were covered with a rotation flap or V-Y advancement flap based on a single perforating branch of the digital artery running from the volar to the dorsal side. This method is useful for the reconstruction of the distal dorsal region of the fingers, because the flap is more mobile, has a smaller skin island and is less invasive compared to the previous flaps. This type of flap conforms to the concept of a perforator flap arising from the main artery.

Distraction arthrolysis using an external fixator and flexor tenolysis for proximal interphalangeal joint extension contracture after severe crush injury.

PURPOSE To introduce a technique for distraction arthrolysis with an external fixator followed by flexor tendon tenolysis for extension contracture of the proximal interphalangeal (PIP) joint after severe crush injury. We also assessed the results of this method in all patients treated. METHODS Five fingers of 4 men with extension contracture of the PIP joint after severe injury underwent distraction arthrolysis using an external fixator, followed by flexor tenolysis. On the day of attaching the external fixator, moderate distraction was applied to the joint and the gap was widened to approximately 2 mm. From the following day onward, the PIP joint was gradually widened for 10 days until a gap of about 5 mm was attained. After sustaining this amount of distraction for 3 or 4 days, the fixator was removed. Passive range of motion was performed for about one week until swelling of the affected digit subsided. Then, flexor tenolysis was performed. Patients were follow-up for an average of 31 months after surgery. RESULTS After tenolysis, the average improvement of active range of motion was 20 degrees, average gain of active flexion was 41 degrees, and average loss of active extension was 21 degrees. The average range of active motion was from 6 degrees to 38 degrees preoperatively, and from 27 degrees to 79 degrees postoperatively. The average median of active motion was 22 degrees preoperatively, and 52 degrees postoperatively. In all fingers, there was no significant difference in the total arc of active motion preoperatively and postoperatively, but there was a significant difference between preoperative and postoperative maximum active flexion. In all patients, painless motion was maintained and arthritic changes of the PIP joint did not worsen during the follow-up period. CONCLUSIONS Distraction arthrolysis with an external fixator followed by flexor tenolysis was a useful treatment for our patients with extension contracture of the PIP joint and tendon adhesions after severe crush injury. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Free arterialised flow-through venous flap with venous anastomosis as the outflow (A-A-V flap) for reconstruction after severe finger injuries

Abstract For reconstruction of volar defects, an arterialised flow-through venous flap (A-A flap) can be used to restore the soft tissues and the digital artery at the same time. However, there have been reports that the circulation of this flap is inadequate. This study used a venous flap with only one venous anastomosis for the outflow of an A-A flap (A-A-V flap) to solve this problem. Six patients with defects of the finger soft tissues and digital artery after severe finger injuries were performed. The venous flap with a Y-shaped vein was harvested. The digital artery was reconstructed, after which the other proximal vein of this flap was anastomosed to the dorsal subcutaneous vein. The flap survived in all patients and histological examination of flap tissue showed a nearly normal architecture. This study describes the good results obtained with an A-A-V flap, and discusses the utility of our flap in comparison with previously reported venous flaps.

Importance of the reconstruction of the extensor retinaculum after injury.

Abstract We reconstructed an extensive soft tissue defect of the dorsum of the left wrist after an injury using a free anterolateral thigh flap and a tendon graft, and intending to substitute the extensor retinaculum for the fascia in this flap. As a result, maximum function of the extension mechanism was restored to the reconstructed hand.

A CASE OF VENOUS VARIX OF THE VOLAR DIGIT AND REVIEW OF THE LITERATURE

Venous varix of the volar digit (VVVD) is a rare condition that is usually described as a firm, blue, and painful mass. However, the clinical features of VVVD are still unclear. We treated a patient who had a firm, normal-skin-colored, and painless mass on the volar aspect of a digit. The mass was removed and was diagnosed as VVVD by histological examination. Magnetic resonance imaging was useful for assisting with the pre-operative diagnosis. We also review 11 previously reported cases.

VENOUS VARIX ON THE DORSAL ASPECT OF THE THUMB: REPORT OF TWO CASES

Venous varix on the volar aspect of the digits or the hand is a rare subcutaneous lesion that is usually described as a firm, blue, and painful single nodule that contains thrombus. However, there have been no reports about venous varix on the dorsal aspect of the digits or the hand, so its features are unknown. We treated two patients who each had a soft blue painless mass on the dorsal aspect of the thumb that became enlarged with the tourniquet test. Ultrasonography and/or magnetic resonance imaging were used for assisting with the preoperative diagnosis, and showed each lesion was composed of two or more varicosities. Each mass was removed and was diagnosed as a venous varix without thrombus by histological examination.