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PubMedDate not supplied

Reconstruction of the thumb and digit by toe to hand transplantation.

Since the rapid development of microsurgery it is feasible to replant most severed thumbs and digits. In certain patients, however, the trauma is so severe that replantation cannot be performed, such as crush or burst injuries where the amputated part is badly smashed or broken into pieces. There are many methods used to reconstruct amputated thumbs or digits. In our hospital reconstruction of the thumb is accomplished by second toe transplantation, nail flap of the great toe transplantation and bone graft, and nail flap of the great toe and skeleton from the second toe transplantation. Reconstruction of fingers is undertaken through second toe transplantation and second and third toe transplantation. After total loss of the hand, double second toe transplant is used for reconstruction.

Adult↗
PubMed1980

Second-toe to hand transplantation: a clinical experience of 25 cases.

Twenty-five cases of second-toe transplantation to replace the thumb and other fingers are reported. There were 20 toal successes, four partial successes and one total failure. A total of eight patients had circulatory complications at some stage after operation. The overall motor and sensory functions of the transplanted toes were highly satisfactory. The donor foot did not suffer functionally despite the absent second toe.

Adolescent↗
PubMed1990

[Absence of blood circulation following toe-hand transplantation in a 7-year-old girl with monodactyle form of symbrachydactyly].

In a toe transplantation in a child with symbrachydactyly the authors were faced with a no-reflow phenomenon. The medication they used in prophylaxis was not an absolute guarantee to prevent this problem. Success also depends on some general measures, as a stable blood pressure, a constant blood volume, normal body temperature, short operation time, and an early revision in case of a no-reflow phenomenon. Some questions about the appearance of spasm still remain: are they provoked by pain, stress, medication as anaesthetics, or is a congenital structural vessel problem responsible?

Angiography↗
PubMed1988

Free serratus anterior muscle transplantation for hand reconstruction.

Free transplantation of the serratus anterior muscle has allowed salvage or reconstruction of difficult hand injuries with advantages compared to traditional methods. Free muscle tissue adds vascularity to poorly vascularised and potentially infected wounds and allows hand elevation and early mobilisation. Dynamic reinnervation is possible with segmental preservation of the long thoracic nerve. The serratus anterior muscle is easily harvested and has a long, reliable vascular pedicle. It is thin, easily contoured to the defect and can be separated into its component slips. The muscle provides stable coverage when covered with a meshed split thickness skin graft. Scapular winging does not occur since only the lower two or three slips of muscle are used. The muscle has been used in 15 complex hand wounds, three within a week of revascularisation or digital replantation for hand salvage. Three dynamic muscle transfers were performed to restore thumb opposition with one simultaneous toe-to-thumb transplantation.

Adolescent↗
PubMed1979

Early complications in second toe to hand transplantation-the occurrences and preventive measures.

The operative experience of twenty cases of second toe to hand transplantations was discussed. Although there was only one total failure, there were frequent complications. The factors leading to the high rate of complications (just over 1/3 of cases) were analysed. A treatment scheme, which took into consideration a large number of precautions and preventive measures against early complications was carefully outlined.

Adolescent↗
PubMed1986

Tissue transplants in primates for upper extremity reconstruction: a preliminary report.

Recent advances in clinical transplantation surgery suggest that hand transplantation is no longer an unrealistic expectation. However, two questions must be answered. Can composite tissue transplants survive in a primate species? Does the required neural reinnervation occur under immunosuppression? Four hand transplants and seven neurovascular free flap transplants were done in baboons immunosuppressed with Cyclosporin A and steroids (methylprednisolone). Long-term survival occurred in nine. Electrophysiologic tests of sensory axons revealed reinnervation of transplanted skin as evidenced by well-defined, low threshold receptive fields in the donor tissue. Reinnervation of donor muscle was demonstrated by motor unit recruitment in stepwise fashion after electrical stimulation of the recipient's median and ulnar nerves. Afferent fibers serving the donor's joints and muscle spindles were also observed.

Animals↗
PubMed1986

[Autoplastic foot-to-hand joint transplantations].

Our surgical experience in the field of total and partial foot-to-hand joint transplants has evolved over the past 9 years (1973). In the case of serious traumatic injury of finger joints of the hand, we don't suggest any surgical solution other than that of arthrodesis or arthroplasty of the damaged joint. In our experience joint transplantation is a reconstructive operation of the whole functionality of the injured finger. This operation partially restores the active function of the finger involved and gives both the patient and the surgeon the possibility of an alternative to arthrodesis, arthroplasty or painful instability of the destroyed joint, thus avoiding their characteristic disabilities. The transplantation guarantees a true stability of the joint and in the majority of cases the disappearance of pain. The technique described are the result of our experience in treating our clinical cases which consist of 20 patients treated, over more than 9 years at the Division of Hand Surgery of Traumatologic and Orthopaedic Center of Turin. The total number of transposed joints is 22, 16 of which are hemiarticular grafts. The operations have concerned 8 M.P. and 14 PIP joints of the fingers.

Adult↗
PubMed1991

[Substitution of soft tissue defects of septic origin on the back of the hand by transplantation of a free composite flap].

Authors report on substitution of severe skin and extensor tendon defect on the back of the hand, developed after a II. grade open septic metacarpal fracture. For the covering of the defect of the soft tissue the paratenon--tendon--skin free flap unit was used, supplied by the a. dorsalis pedis. In one operation the skin in full thickness and the extensor tendons could be substituted at the same time the suppuration was eliminated and the pseudarthroses stabilized with lamellar osteosynthesis.

Accidents, Occupational↗
PubMed1986

[Reconstruction of flexor tendons following prognostically unfavorable injuries in the "no man's land" of the hand using transplantation of a tendon-tendon sheath unit--preliminary report].

For the reconstruction of injured flexor tendons with a bad prognosis in "no man's land", the authors used a composite flexor tendon graft from the foot. In one case, first in the literature, they carried out the transplantation with microvessel anastomosis. They modified the method proposed by Chacha in 1974 in several ways. On the basis of their favourable results they propose the method for reconstruction after flexor tendon injuries with a poor prognosis.

Adult↗
PubMed1984

Experimental models in primates for reconstructive surgery utilizing tissue transplants.

Two experimental models for tissue transplantation between unrelated individuals of a primate species have been designed to study survival and reinnervation. The first is a neurovascular free flap consisting of the entire soft tissue coverage of the index finger. The second is an entire hand transplant through the distal forearm. Ongoing studies show that cyclosporin A at high doses, in combination with a tapering regimen of steroids to a low maintenance level, permits prolonged survival of both transplant models. Careful biochemical, hematological, and cyclosporin A serum trough level monitoring permits use of this drug a very high dosages in primates. Continuing experiments should yield detailed neurophysiological data on the reinnervation of these transplants over the next 6 to 18 months.

Animals↗
PubMed1978

Great toe to hand free tissue transfer.

Thumb reconstruction is a complex subject and the method selected for each patient deserves individual consideration. The method of free toe-to-hand transfer for thumb replacement should be chosen only when the surgeon is familiar with all alternative methods of thumb reconstruction and feels that this technique represents the most reasonable method available. For the surgeon a clear understanding of the anatomic similarities and differences between the normal thumb and great toe are mandatory. In well selected adults and children the failure rate for free toe-to-hand transfer should be very small. The advantages of a single staged thumb replacement from tissue of similar character and quality without local tissue sacrifice are tremendous. With improvement in techniques, experience and case selectiion, much free tissue transfers will actively compete with well established methods of thumb reconstruction. Surely the free toe-to-hand transfer for thumb replacement of today is a forerunner of thumb and hand transplantation of tomorrow.

Adult↗
PubMed1992

Replantation of the radial side of the hand in the rhesus monkey: anatomical and functional aspects. A preliminary study to composite tissue allografting.

Before human hand transplantation can even be considered, an appropriate research model must be studied in a non-human primate. The first ray of the hand, augmented with a radial forearm flap, was chosen as a functional composite tissue graft. Four technically successful replantation of the radial unit have been carried out. One monkey died on the first post-operative day due to cardiac arrythmia. Normal wound healing occurred in the other three animals. In three monkeys, functional sensory and motor recovery was almost complete. The monkeys were able to pick up small particles of food with the index finger and thumb. It is suggested that this model could be used for allogeneic composite tissue transplantation in a non-human primate.

Animals↗
PubMed1983

The neurological mutation staggerer is expressed in embryonic cerebellar transplants matured in the anterior eye chamber of normal mice.

Transplantation of embryonic day 11 cerebellar anlage to the anterior eye chamber of wildtype recipient mice was used to investigate the intrinsic character of the cerebellar mutation staggerer. One phenotypic expression of the staggerer gene in vivo is a postnatal degeneration of cerebellar granule cells. After 43 days of in oculo development cerebellar buds from homozygous staggerer embryos similarly develop into nervous tissues lacking granule cells. On the other hand, transplants of wildtype cerebellar anlagen contain a large population of granule cells. Both the staggerer and wildtype cerebellar transplants had a survival of large neurons, characteristic of Purkinje, Golgi and deep nuclei cells.

Animals↗
PubMed1990

[Transpalmar transplantation of a severed hand to the opposite side: a case report].

A man of 20 got both his upper limbs badly injured by an accident on May 28, 1989. Crush of all the 4 fingers of right hand, traumatic amputation through the left arm with severe damage of soft tissue and burst fracture of bones around left elbow. And so, the chance of providing him a useful hand could only be transpalmar transplantation of the undamaged left hand to the opposite side. This was done urgently to reconstruct a new hand, a hand with its fingers in a reversed order. The wound healed up nicely, the transplanted fore-hand was well taken and the new hand functions satisfactorily, though the natural little finger of left hand takes the place of and works as index one, and the original ring finger of left hand seats the position in and acts as long one; and so on. The details of operative procedure are described and the importance of rehabilitation training is particularly emphasized.

Adult↗