Homodigital neurovascular island flaps in hand surgery. A study of sixty cases.

The homodigital island flap is a useful technique in problem cases such as distal amputation of the pulp, atrophic or insensative pulp on the index finger or thumb and painful neuromas. In a series of 60 operations preformed by one surgeon with the SOS Main in Strasbourg, we describe the indications for, and results of, several different techniques: unipedical flaps either advanced or "exchanged" and bipedical flaps either advanced or retreated.

Toe-to-hand transfers in reconstructive surgery of the hand. Experience with seventy-one cases.

Based on a homogeneous series of 71 toe-to-hand transfers performed between February 1975 and December 1982 the same surgeon, the authors have tried to define their present day indications. Technical modifications have been described for the second toe transfer : isolated dorsal approach of the toe with early-stage resection of the second metatarsal bone, utilisation of the plantar metatarsal artery of the second interosseous space, utilisation of the volar vessels for the anastomosis at the recipient site, dorsal subcutaneous tunnel for the venous anastomosis of the hand. Aside from the usual indications for thumb reconstruction (11 cases) and 26 cases of transfers for reconstruction in long finger injuries, the indications for partial transfers have become more and more frequent : pulpar (9 cases), pulp + bone + nail (10 cases), isolated nail (1 case), nail + bone (2 cases), first web space (1 case), double twisted toe (5 cases) and articular (6 cases) transfers.

[Ungual synthesis]. / La synthèse unguéale.

In case of dorsal sectioning of the distal phalanx, the nail can be used to mobilize and to bring the bone fragments together. A needle is passed through the nail and the nail bed, and the two fragments can be brought together with a metallic tension suture.