This book covers latest advancement of finger reconstruction caused by severe injury leading to finger defects, presenting amount of valuable clinical experience and research achievement. This book provides practical guidance for hand and foot surgeons, micro- and reconstructive surgeons, trauma surgeons, orthopedic surgeons, general practitioners as well as trainees.
The book mainly contains two parts: Part 1 focuses on development of the history of finger reconstruction, applied anatomy of the extremities, commonly used equipment and materials, frequently used medicines, preoperative treatment, selection of anesthesia, fundamental skill for finger reconstruction, postoperative treatment and management and methods of functional recovery after finger reconstruction. It is not uncommon in clinical scenarios that severe traumas caused by high energy damage in hands leading to life-long disability. The initial injury management is crucial. Surgeons face the arduous task of attempting to repair and reconstruct the injuries, reduce the patient’s disability and improve their quality of life. Part 2 demonstrates the concepts of different types of finger reconstruction with key points described by case presentations. Depending on the types and the severity of the lesions, accuracy of doctor’s judgment and proficiency of surgery skill have vital significance during the treatment of hand trauma together with patients’ compliance on functional rehabilitation.
Author(s): Jian Lin, Jianli Wang, Deqing Hu, Yongqing Xu, Tianhao Zhang
Publisher: Springer
Year: 2023
Language: English
Pages: 287
City: Singapore
Contents
Contributors
Part I: Introduction
1: The Development Situation of Finger Reconstruction
1.1 Historical Origin
1.2 Controversial Issues
1.2.1 Focus on Time for Operation
1.2.2 Hallux-to-Thumb Reconstruction, Nail Skin Flap of Great Toe Transplantation, or Second Toe Transplantation for Thumb Defects?
1.2.3 How to Reconstruct Fingers When Multiple Fingers Defect?
1.2.4 Whether to Reconstruct Sensory Nerves?
Further Reading
2: Anatomy of the Hand and Foot
2.1 Holistic View
2.1.1 Superficial Anatomy
Skin Anatomical Marks
Osseous Marks
Osseous Marks on the Hand
Osseous Marks of the Foot
Muscular (Tendon) Marks
Muscular (Tendon) Marks on the Hand
Muscular (Tendon) Marks on the Foot
2.1.2 Hand Positions
Resting Position of the Hand
Functional Position of the Hand
The Pinching Position of the Hand
The Holding Position of the Hand
2.1.3 Body Surface Reflection
Reflection of Hand Bones and Joints (Fig. 2.7)
Reflection of Vascular and Nerves (Figs. 2.8, 2.9, 2.10, 2.11, 2.12, 2.13, 2.14 and 2.15)
Limb Arteries
Limb Veins
Lymphatic Vessels of Limbs
Extrinsic Muscles of Hand and Foot
2.2 Applied Anatomy of the Hand
2.2.1 Dorsum of Hand
Superficial Structures
Dorsal Venous Rete of Hand
Superficial Lymph Vessels
Cutaneous Nerves
Deep Structures
Extensor Retinaculum
Dorsal Deep Facial of Hand
Ficial Space
Tendon of Extenson Digitorum
Dorsal Metacarpal Artery
2.2.2 Palm of Hand
Superficial Structures
Cutaneous Nerves
Palmaris Brevis
Deep Structures
Deep Fascia
Osteofascial Sheath
Fascial Spaces
Synovial Sheath of Palm
Intrinisic Muscles of Hand
Vasculars
Nerves
2.2.3 Fingers
Superficial Structrues
Skin
Nail
Subcutaneous Tissue
Flexor Digitorum
Morphological Structure Characteristics of Flexor Digitorum
Sheath Digitorum
Extensor Digitorum
Morphological Structure Characteristics of Extensor Digitorum
Partition of Extensor Digitorum
2.2.4 Bones of Hand
Carpal Bones
Metacarpal Bone
Phalanges of Finger
Joints and Ligaments of Hand
Radiocarpal Joint
Intercarpal Joint
Mediocarpal Joint
Intermetacarpal Joint
Metacarpophalangeal Joint
Interphalangeal Joint
2.3 Applied Anatomy of the Foot
2.3.1 Dorsum of the Foot
Superficial Structures
Deep Structures
2.3.2 Planta Pedis
Superficial Structures
Deep Structures
2.3.3 Toes
Superficial Structrues
Skin
Toe Nail
Subcutaneous Tissue
Veins of Toe
Nerves of Toe
Deep Structures
Tendons of Toe
Arteries of Toe
Bones of Foot
Tarsal Bone
Talus
Calcaneus
Navicular Bone
Cuboid Bone
Cuneiform Bones
Metatarsal Bones
Phalanges of Toe
Joints and Ligaments of Foot
Ankle (Talocrural)Joint
Intertarsal Joints
Subtalar (Talo-Calcaneal) Joint
Talocalcaneonavicular Joint
Calcaneocuboid Joint
Cuneonavicular Joint
Cuneocuboid Joint and Intercuneiform Joints
Tarsometatarsal Joint
Intermetatarsal Joints
Metatarsophalangeal Joints
Interphalangeal Joint of Foot
2.4 Anatomy of Finger Reconstruction by Transplantation of Foot Flaps
2.4.1 Perforator Flap with Dorsalis Pedis Artery
Applied Anatomy
Dissociation of the Flap
Key Points for Application
2.4.2 Perforator Flap with Dorsal Metatarsal Artery
Applied Anatomy
Dissociation of the Flap
Key Points for Application
2.4.3 Antemalleolar Flap
Applied Anatomy
Dissociation of the Flap
Key Points for Application
2.4.4 Medial Pedis Flap
Applied Anatomy
Medial Plantar Artery
Anterior Medial Malleolar Artery
Medial Tarsal Artery
Perforator of First Plantar Metatarsal Artery
Dissociation of the Flap
Key Points for Application
2.4.5 Lateral Pedis Flap
Applied Anatomy
Lateral Calcaneal Artery
Lateral Tarsal Artery
Anterior Lateral Malleolar Artery
Descending Perforator of Peroneal Artery
Perforator of Fifth Plantar Metatarsal Artery
Dissociation of the Flap
Key Points for Application
2.5 Cutaneous (Perforator) Flaps of Toe
2.5.1 Great Toe Flap
Applied Anatomy
Surgical Method
Key Points for Application
2.5.2 Second Toe Flap
Applied Anatomy
Surgical Method
Key Points for Application
2.5.3 Extensor Digitorum Brevis Flap
Applied Anatomy
Morphology of Extensor Digitorum Brevis
Blood Supply of Extensor Digitorum Brevis
Nerves of Extensor Digitorum Brevis
Surgical Methods
Keypoints for Application
2.5.4 Abductor Hallucis Flap
Applied Anatomy
Morphology of Abductor Hallucis
Blood Supply of Abductor Hallucis
Nerves of Abductor Hallucis
Surgical Methods
Keypoints for Application
2.5.5 Extensor Digitorum Myocutaneous Flap
Applied Anatomy
Morphology of Flexor Digitorum Brevis
Vassculars of Flexor Digitorum Brevis
Nerves of Flexor Digitorum Brevis
Surgical Methods
Keypoints for Application
2.5.6 Abductor Digiti Minimi Flap
Applied Anatomy
Morphology of Abductor Digiti Minimi
Vasculars of Aductor Digiti Minimi
Nerves of Abductor Digiti Minimi
Surgical Methods
Keypoints for Application
2.6 Anatomy of Finger Reconstruction by the Toe and Joint to Hand Transfer
2.6.1 Thumb Reconstruction by Second Toe Transplantation
Arteries
Dorsalis Pedis Artery
First Dorsal Metatarsal Artery
First Plantar Metatarsal Artery
Dorsal and Plantar Digitorum Arteries
Veins
Nerves
Announcements
2.6.2 Finger Reconstruction by Second and Third Toe Transplantation
Arteries
Veins
Nerves
Announcements
2.6.3 Metacarpophalangeal Joints Reconstruction by Second and Third Metatarsophalangeal Joints Transplantation
Applied Anatomy
The Structure of Joints
Blood Supply of Joints
Nerves of Joints
Surgical Methods
Announcements
2.6.4 Metacarpophalangeal/Interphalangeal Joint Reconstruction by Proximal Interphalangeal Joint Transplantation of Second and Third Toe
Applied Anatomy
The Structure of Joints
Blood Supply of Joints
Nerves of Joints
Surgical Methods
Announcements
3: Preoperative Treatment for Finger Reconstruction
3.1 Design and Choice of Operation Plan
3.1.1 Systemic Assessment
3.1.2 Assessment of Finger Stump
Index of Thumb and Other Fingers Defect (Fig. 3.1)
Index of Thumb Defect
Index of Other Finger Defect
Assessment of Skin Condition of Finger Stump
Assessment of Nerve of Finger Stump
Assessment of Tendons
Assessment of Bone and Joint
3.1.3 Assessment of Vascular Condition of Donor and Recipient Site
Observation and Touch
Portable Color Doppler Ultrasonography (Fig. 3.2)
CT Angiography (CTA) (Fig. 3.3)
CE-MRA (Fig. 3.4)
3.1.4 Operation Design
3.1.5 Indications and Contraindications
Indications
Contraindications
3.1.6 Preoperative Preparation
Preparation of Surgical Team
Preparation of Patients
Preparation of Operation Room and Anesthesia
Further Reading
4: Commonly Used Instruments, Equipment, and Materials for Finger Reconstruction
4.1 Commonly Used Microsurgical Instruments, Equipment, and Materials
4.1.1 Operating Microscope (Figs. 4.1 and 4.2)
History of Operating Microscope
Advantages of Operating Microscopes
Requirements for Operating Microscope
4.1.2 Operating Magnifying Glasses
4.1.3 Microsurgical Instruments (Figs. 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 4.10 and 4.11)
4.1.4 Microsurgical Suture Materials
Further Reading
5: Common Medicines Used for Finger Reconstruction
5.1 Antibiotic Drugs
5.1.1 Penicillin
Adverse Reactions
Notices
5.1.2 Cephalosporins
Adverse Reactions
Notices
5.1.3 Macrolide Antibiotics
Adverse Reactions
Notices
5.1.4 Polypeptide Antibiotic
Adverse Reaction
Notices
5.1.5 Antifungal Drugs
Adverse Reactions
Notices
5.2 Anticoagulant Drugs
5.2.1 Low Molecular Dextran
Adverse Reactions
Notices
5.2.2 Heparin
Adverse Reaction
Notices
5.2.3 Aspirin
Adverse Reaction
Notices
5.3 Antispasmodic Drugs
5.3.1 Papaverine
Adverse Reactions
Notices
5.3.2 Tolazoline
Adverse Reactions and Notices
5.4 Other Drugs
5.4.1 Hibernation Drugs
Adverse Reaction
Notices
5.4.2 Analgesia Pump
Adverse Reactions
Notices
Further Reading
6: Selection of Anesthesia for Finger Reconstruction
6.1 Requirements for Anesthesia
6.1.1 No Pain at the Surgical Site
6.1.2 Adequate Limb Perfusion
6.1.3 Prevention of Vasospasm
6.1.4 Postoperative Analgesia
6.2 Methods of Anesthesia
6.2.1 General Anesthesia
6.2.2 Region Block Anesthesia
Subarachnoid Block Anesthesia
Epidural Block Anesthesia
Peripheral Nerve Block Anesthesia
Brachial Plexus Block
Sciatic Nerve Block Anesthesia
Femoral Nerve Block Anesthesia
Lateral Femoral Cutaneous Nerve Block Anesthesia
Obturator Nerve Block Anesthesia
Peri-Ankle Nerve Block Anesthesia
Peri-Elbow Nerve Block Anesthesia
Peri-Wrist Nerve Block Anesthesia
6.3 Selection of Anesthesia
7: Fundamental Skill for Finger Reconstruction
7.1 Micro-Suture Operation Training of Small Blood Vessels
7.1.1 Training Should Be Step by Step
7.1.2 Placement and Use of Microsurgery Instruments
7.1.3 Select Needle and Thread According to Vessel Diameter
7.1.4 Distance Between Suture Stitches, Breadth of Suturing Margin, and Number of Stitches Should Be Appropriate
7.2 Skill and Key Points for Small Blood Vessel Suture
7.2.1 Clear Exposure of Blood Vessels
7.2.2 The Suture Must Be in the Normal Vascular Segment
7.2.3 The Size of Anastomosed Vessels Should Be Similar
7.2.4 The Tension of Blood Vessels Should Be Proper
7.2.5 The Operation Should Be Steady, Accurate, Light, and Skillful
7.2.6 Distance Between Suture Stitches, Breadth of Suturing Margin, and Number of Stitches Should Be Appropriate
7.2.7 Proper Trim of Outer Membrane at Broken End and Flushing
7.2.8 Maintain the Vascular Bed Healthy and Flat
7.2.9 Stitching and Knotting Should Be Accurate and Proper
7.2.10 The Sequence of Stitches Should Be Proper
7.3 Suture Methods
7.3.1 End-to-End Anastomosis
Three Stay Sutures End-to-End Anastomosis (Fig. 7.1)
Two Stay Sutures End-to-End Anastomosis (Figs. 7.2 and 7.3)
Nonequidistant Two Stay Sutures End-to-End Anastomosis (Fig. 7.4)
Isometric Four Stay Sutures End-to-End Anatomosis of the Anterior Wall (Fig. 7.5)
Isometric Four Stay Sutures End-to-End Anatomosis of the Posterior Wall (Figs. 7.6 and 7.7)
Continuous Anastomosis (Figs. 7.8 and 7.9)
Side Wall Stayed Sutures Anastomosis
End-to-Side Anastomosis
Sleeve Insertion Anastomosis
Small Vessel Transplantation
Notices
References
Further Reading
8: Postoperative Management for Finger Reconstruction
8.1 Postoperative Treatment and Management
8.1.1 Postoperative Observation and Management (Figs. 8.1, 8.2, 8.3, 8.4, 8.5, 8.6, 8.7, 8.8 and 8.9)
Observation and Treatment of a Systemic Condition
Observation of Vital Signs
Observation of Blood Volume and Peripheral Circulation
Observation of the Amount of Liquid in and out
Observation of Uncomfortable Symptoms
Local Observation of Reconstructed Fingers
Changes of Color
Changes of Temperature
Changes of Skin Tension
Blood-Letting Test
Observation of Wound Bleeding
8.1.2 Drug Treatment
Prevention of Infection
Antipasmodic Therapy
Anticoagulation Therapy
Postoperative Analgesia
Neurotrophic Therapy
Blood Volume Augmentation Therapy
8.1.3 Judgment and Management of Vascular Crisis
Arterial Crisis
Arterial Spasm
Arterial Thrombosis
Venous Crisis
Treatments after Exploration
8.2 Cause Analysis and Prevention of Vascular Crisis
8.2.1 Cause Analysis
Prevention of Vascular Crisis
Further Reading
9: Functional Rehabilitation for Finger Reconstruction
9.1 Staging of Function Rehabilitation After Finger Reconstruction
9.2 Common Rehabilitation Methods
9.3 Rehabilitation Features of Finger Reconstruction
9.4 The Significance of Functional Rehabilitation
Further Reading
Part II: Different Types of Finger Reconstruction
10: Reconstruction of Thumb Defects
10.1 Reconstruction of Type I Defect of the Thumb
10.1.1 Indications
10.1.2 Surgical Design
10.1.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
10.1.4 Operation Characteristics
10.1.5 Announcements
10.1.6 Case Description
10.2 Reconstruction of Type II Defect of the Thumb
10.2.1 Indications
10.2.2 Surgical Design
10.2.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
10.2.4 Operation Characteristics
10.2.5 Announcements
10.2.6 Case Description
10.3 Reconstruction of Type III Defect of the Thumb
10.3.1 Indications
10.3.2 Surgical Design
10.3.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
10.3.4 Operation Characteristics
10.3.5 Announcements
10.3.6 Case Description
10.4 Reconstruction of Type IV Defect of the Thumb
10.4.1 Indications
10.4.2 Surgical Design
10.4.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
10.4.4 Operation Characteristics
10.4.5 Announcements
10.4.6 Case Description
10.5 Reconstruction of Type V Defect of the Thumb
10.5.1 Indications
10.5.2 Surgical Design
10.5.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
10.5.4 Operation Characteristics
10.5.5 Announcements
10.5.6 Case Description
10.6 Reconstruction of Type VI Defect of the Thumb
10.6.1 Indications
10.6.2 Surgical Design
10.6.3 Surgical Method
10.6.4 Postoperative Treatment
10.6.5 Operation Characteristics
10.6.6 Announcements
10.6.7 Case Description
11: Reconstruction of Single Finger Defects
11.1 Reconstruction of Type I Defect
11.1.1 Indications
11.1.2 Surgical Design
11.1.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
11.1.4 Operation Characteristics
11.1.5 Announcements
11.1.6 Case Description
11.2 Reconstruction of Type II Defect
11.2.1 Indications
11.2.2 Surgical Design
11.2.3 Surgical Method
11.2.4 Operation Characteristics
11.2.5 Announcements
11.2.6 Case Description
11.3 Reconstruction of Type III Defect
11.3.1 Indications
11.3.2 Surgical Design
11.3.3 Surgical Method
Preparaion for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
11.3.4 Operation Characteristics
11.3.5 Announcements
11.3.6 Case Description
11.4 Reconstruction of Type IV Defect
11.4.1 Indications
11.4.2 Surgical Design
11.4.3 Surgical Method
Preparaion for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
11.4.4 Operation Characteristics
11.4.5 Announcements
11.4.6 Case Description
11.5 Reconstruction of Type V Defect
11.5.1 Indications
11.5.2 Surgical Design
11.5.3 Surgical Method
Preparaion for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
11.5.4 Operation Characteristics
11.5.5 Announcements
11.5.6 Case Description
11.6 Reconstruction of Type VI Defect
11.6.1 Indications
11.6.2 Surgical Design
11.6.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
11.6.4 Operation Characteristics
11.6.5 Announcements
11.6.6 Case Description
12: Reconstruction of Multi-Finger Defects
12.1 Indications
12.2 Surgical Design
12.3 Surgical Method
12.3.1 Preparation for the Recipient Site
12.3.2 The Cutting of the Toe
12.3.3 Transplantation
12.3.4 Postoperative Treatment
12.4 Operation Characteristics
12.4.1 Announcements
12.4.2 Case Description
13: Reconstruction of Finger Joint Defects
13.1 Indications
13.2 Surgical Design
13.3 Surgical Method
13.3.1 Preparation for the Recipient Site
13.3.2 The Cutting of the Toe
13.3.3 Transplantation
13.3.4 Postoperative Treatment
13.4 Operation Characteristics
13.5 Announcements
13.6 Case Description
14: Reconstruction of Nail Defects
14.1 Reconstruction of Nail Defect by Split-Thickness Toenail Bed Transplantation
14.1.1 Indications
14.1.2 Surgical Design
14.1.3 Surgical Method
14.1.4 Postoperative Treatment
14.1.5 Operation Characteristics
14.1.6 Announcements
14.2 Reconstruction of Nail Defect by Superficial Dermal Fascia Composite Tissue Transplantation
14.2.1 Indications
14.2.2 Surgical Design
14.2.3 Surgical Method
14.2.4 Operation Characteristics
14.2.5 Announcements
14.3 Reconstruction of Nail Defect by Toenail Flap Transplantation
14.3.1 Indications
14.3.2 Surgical Design
14.3.3 Surgical Method
Preparation for the Recipient Site
Preparation for the Donor Site
The Cutting of the Toe (Take the Toenail Flap of the Great Toe for Example)
Transplantation
Postoperative Treatment
14.3.4 Operation Characteristics
14.3.5 Announcements
14.3.6 Case Description
15: Reconstruction of Finger Pulp Defects
15.1 Reconstruction of Finger Pulp Defect by Local Thumb Flap
15.1.1 Indications
15.1.2 Surgical Design
15.1.3 Surgical Method
15.1.4 Operation Characteristics
15.1.5 Announcements
15.1.6 Case Description
15.2 Reconstruction of Finger Pulp Defect by Transposition of Local Finger Flap
15.2.1 Indications
15.2.2 Surgical Design
15.2.3 Surgical Method
15.2.4 Operation Characteristics
15.2.5 Announcements
15.2.6 Case Description
15.3 Reconstruction of Thumb Pulp Defect by Transposition of Dorsal Index Finger Flap
15.3.1 Indications
15.3.2 Surgical Design
15.3.3 Surgical Method
15.3.4 Operation Characteristics
15.3.5 Announcements
15.3.6 Case Description
15.4 Reconstruction of Finger Pulp Defect by Digital Artery Island Flap
15.4.1 Indications
15.4.2 Surgical Design
15.4.3 Surgical Method
Proper Digital Neurovascular Island Flap
15.5 Proper Digital Artery Island Flap Anastomosed with Dorsal Digital Nerve
15.5.1 Operation Characteristics
15.5.2 Announcements
15.5.3 Case Description
15.6 Reconstruction of Finger Pulp Defect by Great Toe Pulp Flap Transposition
15.6.1 Surgical Design
15.6.2 Surgical Method
The Thumb Pulp Defect
The Finger Pulp Defect
15.6.3 Operation Characteristics
15.6.4 Announcements
15.6.5 Case Description
16: Reconstruction of Dorsal Digital Composite Tissue Defects
16.1 Indications
16.2 Surgical Design
16.3 Surgical Method
16.4 Operation Characteristics
16.5 Announcements
16.6 Case Description
17: Special Types of Finger Reconstruction
17.1 Aesthetic Reconstruction (Comprehensive Reconstruction)
17.1.1 Indications
17.1.2 Surgical Design
17.1.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
17.1.4 Operation Characteristics
17.1.5 Announcements
17.1.6 Case Description
17.2 Finger Reconstruction in Children
17.2.1 Indications
17.2.2 Surgical Design
17.2.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
17.2.4 Announcements
17.2.5 Case Description
17.3 Reconstruction of Congenital Deformity of Fingers
17.3.1 Indications
17.3.2 Surgical Design
17.3.3 Operation Characteristics
17.3.4 Announcements
17.3.5 Case Description
17.4 Reconstruction of Degloving Defects of Fingers
17.4.1 Indications
17.4.2 Surgical Design
17.4.3 Surgical Method
Preparation for the Recipient Site
The Cutting of the Toe
Transplantation
Postoperative Treatment
17.4.4 Operation Characteristics
17.4.5 Announcements
17.4.6 Case Description
17.5 Reconstruction of Finger Defects by Transpositional Replantation of Ampuated Finger
17.5.1 Indications
17.5.2 Surgical Design
17.5.3 Surgical Method
17.5.4 Postoperative Treatment
17.5.5 Operation Characteristics
17.5.6 Announcements
17.5.7 Case Description
17.6 Temporary Heterotopic Replantation (Reconstruction) of Severed Fingers
17.6.1 Indications
17.6.2 Surgical Design
17.6.3 Surgical Method
17.6.4 Postoperative Treatment
17.6.5 Operation Characteristics
17.6.6 Announcements
17.6.7 Case Description
Further Reading
