• Archives of Plastic Surgery
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• v.42 no.3
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• pp.334-340
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• 2015

Background Full-thickness skin grafts (FTSGs) are generally considered unreliable for coverage of full-thickness finger defects with bone or tendon exposure, and there are few clinical reports of its use in this context. However, animal studies have shown that an FTSG can survive over an avascular area ranging up to 12 mm in diameter. In our experience, the width of the exposed bones or tendons in full-thickness finger defects is <7 mm. Therefore, we covered the bone- or tendon-exposed defects of 16 fingers of 10 patients with FTSGs. Methods The surgical objectives were healthy granulation tissue formation in the wound bed, marginal de-epithelization of the normal skin surrounding the defect, preservation of the subdermal plexus of the central graft, and partial excision of the dermis along the graft margin. The donor site was the mastoid for small defects and the groin for large defects. Results Most of the grafts (15 of 16 fingers) survived without significant surgical complications and achieved satisfactory functional and aesthetic results. Minor complications included partial graft loss in one patient, a minimal extension deformity in two patients, a depression deformity in one patient, and mild hyperpigmentation in four patients. Conclusions We observed excellent graft survival with this method with no additional surgical injury of the normal finger, satisfactory functional and aesthetic outcomes, and no need for secondary debulking procedures. Potential disadvantages include an insufficient volume of soft tissue and graft hyperpigmentation. Therefore, FTSGs may be an option for treatment of full-thickness finger defects with bone or tendon exposure.

• Archives of Reconstructive Microsurgery
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• v.18 no.1
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• pp.27-30
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• 2009

Purpose: Recently, replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. However the replantation of fingertip in adults is a well-established procedure, but the replantation in infant or child is still uncommon. Therefore we present one case of replantation of the fingertip of the small finger in 12-months-old patient. Methods: We experienced a 12-months-old male amputation of small finger. It had been amputated completely at the level of Zone I by Yamano classification. Replantation was performed using the arteryonly technique with neither vein nor nerve repair. Because the artery has been damaged, it is still possible to make a direct suture by transposing the arterial arch in an inverted Y to I arterial configuration. Venous drainage was provided by an external bleeding method with partial nail excision and repaired margin for approximately 7 days. Results: We were performed replantation in infant with only-arterial anastomosis successfully, result in good recovery of aesthetic and functional outcome. Conclusion: In conclusion, although fingertip injury was difficult to replantation in infant and child, we must try it. Because of its functional and cosmetic advantage.

• 제어로봇시스템학회:학술대회논문집
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• 1990.10a
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• pp.52-56
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• 1990

An algorithm is proposed to determine the optimal contact forces of robotic hands, where the soft finger contact as well as the frictional point contact are considered. Especially, the algorithm can be efficiently applied to the case of multi-point contact by inner-link as well as fingertip. To show the validities of the algorithm, several numerical exampies are presented by employing a robotics hand with three fingers each of which has four joints.

• Archives of Reconstructive Microsurgery
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• v.3 no.1
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• pp.54-63
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• 1994

Pulp and palm of the hand and heel of the sole are anatomically unique. Satisfactory reconstruction of these areas presents the plastic surgeon with many challenges and requires durable and sensible skin coverage, minimal donor morbidity and reliable operative procedure. We presents 7 clinical cases of sensate instep free flap transfer in this paper during the last 2 years. Three cases were soft tissue defects due to crushing and avulsion injury on the pulp of finger. 1 case was unstable scar and redundant flap after reconstruction of soft tissue dect of palm and 1 case was contracture of first web of hand. One case was a soft tissue defect due to avulsion injury on heel. Lastly, one case was chronic osteomyelitis with open wound on lateral malleolar area. Follow-up period ranged from 3 months to 2 years. Through the whole follow-up period, all flaps were viable and durable to persistant stress or weight bearing and were sensible enough to porotect the recocstructed area from injuries and maintain functions. In conclusions, the instep free flap should be considered as a valuable tool in reconstruction of hand and extremity requiring durability and sensation.

• Archives of Reconstructive Microsurgery
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• v.21 no.2
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• pp.131-136
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• 2012

Purpose: Arterialized venous flap is useful for reconstruction of the traumatic soft tissue defect in fingers, but insufficient circulation of the traumatic fingers makes surgeons annoying to use the flap. We have grafted flaps in 7 fingers with insufficient vascular bed hoping to expanded the category of the flap. Materials and Methods: Arterialized venous flap have transplanted in 7 fingers from March 2008 through February 2010 and followed up for 4 to 16 months(average 7.2 months). They were all male with a mean age at the time of surgery was 33. The main injury was crushing in 4 degloving, contact burn and saw injury was I respectively. Time interval from injury to flap transplantation was average 3.1. weeks(3 days to 6 weeks). Designed flap size ranges from $8cm{\times}3.5cm$to $4cm{\times}3cm$. Vessel type of flap was one artery with two veins were 5 cases and one artey with one vein 2. Flap type was cutaneous in 3, tendocutaneous 2, neurotendocutaneous 1 and neurocutaneous 1. The circulation state of recipient site was avascular in 2 cases, insufficiency 3 and tip avascular 2. Results: Arterialized venous flap was complete survived in 2 cases, partial necrosis(less than 10%) 3 and failed in 2. Conclusion: An arterialized venous free flap could be a useful procedure for reconstruction in soft tissue or combined defect of the finger despite an avascular or insufficient vascular beds if the recipient beds were free from infection.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.451-459
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• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.103-109
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• 2000

Purpose : We performed this study in order to analyze the clinical results of functioning gracilis musculocutaneous free flap transplantation for reconstructon of hand function in cases of Volkmann's ischemic contracture and massive soft tissue injury of forearm. Materials and methods : 18 cases were reviewed with 5 yeas of mean follow up period. We evaluated total active motion of the finger joints and wrist, pinch and grip strength. Results : The flap were survived in 17 cases and 1 case was failed due to infection. The sum of active motion of finger joints(TAM) was improved from 0 to $173.8^{\circ}$. The average grip and pinch strength was improved from 0 kg to $2.7{\pm}2.1kg$ and from 0 kg to $2.4{\pm}1.6kg$. Conclusion : The results in most cases were acceptable in relatively long term follow-up. It may be an option for reconstruction of hand function in cases of Volkmann's ischemic contracture and traumatic upper extremity injury.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.493-496
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• 2009

Purpose: Glomus tumors are neoplasms that are composed of modified smooth muscle cells of the glomus body and multiple glomus tumor comprises 10% of all glomus tumors. We report a case of disseminated multiple glomus tumors. Methods: A 14 - year - old boy presented with multiple subcutaneous purple nodules on the right cheek, back, right arm, right hand dorsum, right fourth finger, and left ankle. Nodules on the back and right fourth finger were completely excised under local anesthesia and histopathologic examination was followed. Results: Histopathologic findings showed numerous dilated, cavernous - like, thin - walled, vascular spaces surrounded by one or a few layers of glomus cells. On immunohistochemical examination, glomus cells stain for smooth muscle actin, and endothelial cells stain for CD31. Those revealed multiple glomangiomas. Conclusion: A review of Korean literature revealed only one reported cases of disseminated multiple glomus tumors, so this is the second case to be reported in the Korean literature. In case of multiple soft tissue tumors, thorough physical examination and preoperative evaluation is needed.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.2
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• pp.80-84
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• 2014

Inclusion body fibromatosis is a rare benign soft tissue neoplasm typically involving fingers and toes of children in mostly less than one year old. Histologic findings include spindle-shaped fibroblasts surrounded by dense stroma and small perinuclear eosinophilic inclusions in the cytoplasm. Although the tumor typically undergoes spontaneous regression, surgery is considered when functional impairment or deformity develops with the lesion. Unfortunately, recurrence rate was reported to be as high as 60 % following tumor excision. Authors would like to present our case where the tumor occurred in relatively older child and kissing lesion was found a few months after the surgery.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.75-81
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• 2007

Introduction: Microsurgical replantation of amputated digit have become common procedure in recent years. However replantation of fingertip amputation, Zone I by Yamano classification, is still difficult because digital arteries branch into small arteries and also digital veins are hard to separate from the immobile soft tissue. So, fingertip amputation was covered by volar V-Y flap, composite graft, cross finger flap and groin flap. But patients who have been treated by these methods experience shortening of digit, nail deformity, excessive tenderness and persistent pain. Replantation could solve most of these problems. Material & Methods: In our department, from March 2004 to August 2007, 36 digits in 32 patients with complete amputation at distal to nail base were replanted using a microsurgical technique. Results: The overall survival rate of the replanted finger was 75%. Venous anastomosis was possible in 8 cases and impossible in 28 cases. In latter cases external bleeding technique was applied with medical leech. Conclusion: After replantation, a few patient complained decreased sensibility, nail deformity and cold intolerance. But most of patients were satisfied with the functional and cosmetic appearance of the viable replanted digits. We believe the replantation should be the first choice in fingertip amputation.