Distal finger reconstruction technique combining a distally-based finger flap and a partial toe flap.

BACKGROUND: Although aesthetic reconstruction of an amputated distal finger can be achieved through partial toe transfer, this approach often damages the weight-bearing region of the toe from which the flap is harvested. The purpose of this report is to introduce the minimum invasive surgery technique to reconstruct the distal finger aesthetically without damaging the weight-bearing region of the toe. PATIENTS AND METHODS: Thirty-one amputated fingertips in 30 patients aged 18 to 68 years were treated using this operative technique. Operations were performed between January 2010 and December 2020. All patients were missing the distal finger beyond the PIP joint, and the amputation stump had been covered with healthy skin. A distally based finger flap was elevated at the recipient site, and a slender partial toe flap, including the nail, was harvested from the great toe. These flaps were combined to form the distal finger. In all cases, the weight-bearing region of the toe remained intact. The donor site wound was first closed with artificial dermis, and skin grafting was performed 3 weeks after the surgery. A few patients did not require skin grafting because their wounds epithelized spontaneously. RESULTS: In most patients, the transplanted flap remained healthy and the distal finger was aesthetically restored. Two patients aged over 60 years who were smokers developed necrosis of the transplanted partial toe flap. In all patients, the weight-bearing region of the great toe was intact, and they had no trouble walking during the three-year follow-up period after surgery. CONCLUSION: Our technique, which combines elevation of a distally-based finger flap and transplantation of a partial toe flap, was able to minimize the skin defect area in the great toe. This new distal finger reconstruction technique is minimally invasive and can be used to prevent secondary donor site issues.

Angiogenesis after administration of basic fibroblast growth factor induces proliferation and differentiation of mesenchymal stem cells in elastic perichondrium in an in vivo model: mini review of three sequential republication-abridged reports.

To date, studies on mesenchymal tissue stem cells (MSCs) in the perichondrium have focused on in vitro analysis, and the dynamics of cartilage regeneration from the perichondrium in vivo remain largely unknown. We have attempted to apply cell and tissue engineering methodology for ear reconstruction using cultured chondrocytes. We hypothesized that by inducing angiogenesis with basic fibroblast growth factor (bFGF), MSCs or cartilage precursor cells would proliferate and differentiate into cartilage in vivo and that the regenerated cartilage would maintain its morphology over an extended period. As a result of a single administration of bFGF to the perichondrium, cartilage tissue formed and proliferated while maintaining its morphology for at least 3 months. By day 3 post bFGF treatment, inflammatory cells, primarily comprising mononuclear cells, migrated to the perichondrial region, and the proliferation of matrix metalloproteinase 1 positive cells peaked. During week 1, the perichondrium thickened and proliferation of vascular endothelial cells was noted, along with an increase in the number of CD44-positive and CD90-positive cartilage MSCs/progenitor cells. Neocartilage was formed after 2 weeks, and hypertrophied mature cartilage was formed and maintained after 3 months. Proliferation of the perichondrium and cartilage was bFGF concentration-dependent and was inhibited by neutralizing antibodies. Angiogenesis induction by bFGF was blocked by the administration of an angiogenesis inhibitor, preventing perichondrium proliferation and neocartilage formation. These results suggested that angiogenesis may be important for the induction and differentiation of MSCs/cartilage precursor cells in vivo, and that morphological changes, once occurring, are maintained.

A new surgical strategy for reconstruction of claw nail deformity.

Claw nail deformity is common in patients with fingertip injury. The optimal reconstruction remains unclear. We devised a unique strategy for reconstruction of claw nail deformity. We divided the approach into three parts: soft tissue reconstruction, bone graft and nail bed graft. In the soft-tissue reconstruction, a reverse digital arterial finger flap for the finger or an extended palmar flap advancement with V-Y plasty for the thumb was selected. A part of the distal phalanx of the second toe including periosteum was harvested as a bone graft. A nail bed graft from the big toe was performed. We reconstructed in 11 cases of claw nail deformity using our strategy. All cases achieved significant improvement with no recurrence of the claw nail deformity. Moreover, there was no donor site morbidity.