Arthroscopically guided osteotomy for management of intra-articular distal radius malunions.

Purpose: A malunion with a step-off of 1 mm or more after an intra-articular distal radius fracture may cause pain and arthritic changes at midterm follow-up. We present our technique for treating intra-articular distal radius malunions by carrying out an osteotomy from inside the joint outward under arthroscopic guidance using the dry arthroscopy technique, with emphasis on the clinical and radiologic outcomes.

Methods: We performed surgery on 11 patients for intra-articular malunion of the distal radius 1 to 5 months after the injury.

Late salvage of the ischemic finger after crush injury using flow-through flaps: case report.

The progressive evolution and late salvage of a posttraumatic digit with poor vascularization has not been discussed in the literature. We report the cases of 3 patients whose fingers were rescued at referral 5 to 16 days after the traumatic event by restoring the arterial inflow by means of flow-through free flaps. All 3 fingers were compromised vascularly with patchy necrosis and absence of Doppler signal distal to the injury.

Super-thinned iliac flap for major defects on the elbow and wrist flexion creases.

Four free iliac flaps were used to treat or prevent flexion contracture at the elbow or wrist flexion crease. Flap size ranged from 13 x 6 cm to 18 x 8 cm. Two flaps were used for primary coverage, and the other 2 flaps were used to treat established flexion contractures.

Ischemic toe encountered during harvesting: report of 6 cases.

Local vessel disease causing lack of arterial inflow at the time of toe harvesting represents a surgical emergency. In a personal experience of 194 toe transfers to the hand, 6 cases (in 4 patients) were found to have diseased vessels at the first web to the point that acute ischemia of the toe occurred when the tourniquet was released at the lower limb. We report our experience in these 6 cases.

A technique to improve foot appearance after trimmed toe or hallux harvesting.

We describe a technique to improve the appearance of the donor site after hallux harvesting. The surgery has been used in 6 consecutive patients having a trimmed-toe-type transfer. Instead of the classic stump closure advised by Wei, the following steps were performed on the donor site: (1) removal en bloc of the second metatarsal and transposition of the second toe on top of the proximal phalanx of the hallux, (2) interposition of a tibial (medial) glabrous flap from the tibial aspect of the hallux onto the tibial side of the second toe to increase its size, and (3) eponichial flap to increase the nail show on the second toe.

The tibial second toe vascularized neurocutaneous free flap for major digital nerve defects.

Purpose: Most digital nerve defects can be reconstructed by means of nonvascularized nerve grafts or artificial tubes, for example. When the bed is poor, the defect is long, or there is a concomitant soft-tissue loss; however, a vascularized nerve graft may be a better option. Our purpose is to introduce a method of 1-stage reconstruction of complex neurocutaneous defects in the fingers and to report the results and clinical effectiveness at a minimum 1-year follow-up period.

Vascularized bone blocks from the toe phalanx to solve complex intercalated defects in the fingers.

Purpose: Vascularized bone transplants resist infection and allow rapid healing but keeping small bony segments vascularized, as needed for a finger defect, is a challenge. The purpose of this article is to present a cohort of patients with traumatic intercalated compound bony defects in the fingers that were reconstructed by a vascularized toe phalanx (or part of a phalanx) in a single stage.

Methods: Eight patients were treated with an intercalary vascularized bone graft that included a part of the proximal phalanx (3 patients), most of the middle phalanx (4 patients), or a portion of each phalanx (1 patient) of a second toe (totaling 9 bone blocks).