Single longitudinal dorsal incision approach to transfer the flexor digitorum longus tendon between the flexor digitorum brevis hemitendons: a cadaveric study.

Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammertoe deformities. The most common technique uses two cutaneous incisions, one plantar and another dorsal. We performed a cadaveric study to determine whether the flexor digitorum longus tendon could be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique single longitudinal central dorsal incision. The rationale for this novel approach was to minimize the risk of vascular compromise to the digit associated with the two-incision approach. Transposition of the flexor digitorum longus tendon was attempted in 120 toes of cadaveric feet (60 each second and third digits) through a central longitudinal dorsal incision. The flexor digitorum longus tendon segment was long enough to be successfully transposed between the flexor digitorum brevis hemitendons of the second and third toes in 100% of the cases using the central longitudinal dorsal incision approach, with a resection arthroplasty at the proximal interphalangeal joint. Transfer of the flexor digitorum longus tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammertoe deformities in the second and third digits. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon and its longitudinal incision are essential to the successful transfer of the flexor digitorum longus tendon between the flexor digitorum brevis hemitendons.

Effects of digital tourniquet ischemia: a single center study.

BACKGROUND: There is little information regarding the detrimental effects of tourniquet ischemia, although it is a widely used technique in extremity surgery. We endeavored to study some of the physiologic changes involved in the finger during the ischemic phase and throughout the recovery phase after tourniquet release. MATERIALS AND METHODS: This was a single-center, prospective observational study involving healthy adults designed to assess the appropriate application time of a digital T-ring tourniquet without a pH or acidosis <7.0 to avoid any potential risk to local tissues. RESULTS: There was no pH difference before tourniquet application between men and women, but after tourniquet application, the women's fingers became more acidotic at 10 and 20 minutes than the mens', but after 30 minutes the acidosis of the two groups was similar. Participants who weighed less had a more acidotic pH level than heavier participants. LIMITATIONS: This study was performed in a laboratory setting on healthy people rather than on those with existing medical conditions, so clinical recommendations cannot be explicitly made. CONCLUSION: Tourniquet application time is precious. While operating under tourniquet control, the extremity becomes increasingly acidotic. Tourniquet ischemia longer than 20 minutes causes local acidosis and muscle fatigue. Women and persons who weighed less could reach acidotic pH values faster than men or heavier patients. If applications longer than 20 minute are expected, the tourniquet should be released at 20 minutes, allowing the finger to reperfuse for 3-5 minutes to clear the acidosis before reapplication of tourniquet.