Partial medial second toe pulp free flap and dermal substitute with skin graft for salvage reconstruction of a complete skin envelope degloving of the small finger.

Skin envelope degloving of fingers are rare injuries that require rapid care and surgical treatment. Mostly caused by ring finger injuries, these traumas include bone, tendon and neurovascular pedicle damage. The authors present an unusual case of finger degloving limited exclusively to the skin envelope, without skeletal, tendinous or vascular lesion. This rare case of skin envelope degloving rendered microsurgical revascularization impossible. The authors report the results at 12 months following salvage reconstruction combining a partial second toe pulp free flap for the volar side and a dermal substitute with a thin skin graft for the dorsum.

Dorsal locking plates versus staples in four-corner fusion: a comparative clinical and radiological study.

INTRODUCTION: Four-corner fusion was described in 1984 by HK Watson for the treatment of SLAC wrist. This intervention has undergone few changes since that description, but the debate on the fixation method is still not resolved. HYPOTHESIS: Dorsal locking plates provide better stability, short immobilization and a quicker return to daily activities than traditional fixation methods such as staples. MATERIALS AND METHODS: Thirty-one fusions using the Medartis Aptus Four-Corner Fusion(®) plate at a mean 13.1 months' follow-up and 35 using staples at a mean 80.4 months' follow-up were reviewed in a clinical and radiographic retrospective comparative study. RESULTS: Results were comparable between the two groups in terms of range of motion (flexion-extension arc of 67.3° for plates and 60.6° for staples), force (29.6 and 28 kg.F), pain and disability (PRWE 34.8/150 and 40.9; QuickDASH 19.83/100 and 30). Mean time off work was significantly shorter in the plate group (4.5 vs. 7.9 months). There were no non-unions in the plate group, versus 2 in the staples group. Dorsal impingement implicating hardware was also less frequent in the plate group (2 vs. 11). DISCUSSION: The dorsal locking plate did not improve final results in four-corner fusion in terms of range of motion, force, pain or function compared to staples. However, it provided stable fixation, allowing a shorter immobilization and a quicker return to work. Although the initial cost is higher, it could allow significant savings on postoperative costs, shifting the technical debate into the field of public health. LEVEL OF EVIDENCE: Level IV, retrospective study.