Repair of Thumb Defect by Using the Toe Nail Flap

NCT ID: NCT03879941

Last Updated: 2019-03-19

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 29 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2013-03-01
• Study Completion Date: 2018-06-01

Brief Summary

The thumb accounts for 50% of the total hand function. This study reports the functional outcomes and complications of people with traumatic thumb amputations who underwent toe-to-thumb reconstruction.From 2013-01 to 2018-01, 29 patients with second-degree thumb defect underwent thumb reconstruction with distal phalangeal braided toenail flap. The footscan foot pressure gait analysis system was used to measure the index changes of the same foot before and after one, three and six months. The contact area, peak pressure, impulse value, contact time of each gait phase, centre of gravity coordinate and foot balance were analysed statistically. Twenty-nine cases of thumb reconstruction recovered well. After following up for 6-15 months, the appearance of the reconstructed thumb was close to normal, and the sensation was restored to S3+. The two-point discrimination was 6-8 mm, and the function of the thumb was good. The function of the donor foot was well restored, and no skin ulceration, pain and claudication were noted during walking. Compared with that before operation, the biomechanical indices of the donor foot were basically restored to normal six months after operation. Only the stress and impulse values of the third metatarsal head were significantly increased, forming a stress concentration area centred on the third metatarsal head.This study confirmed that the toe nail flap with distal phalangeal bone restored the second-degree thumb defect without destroying the main functional structure of the sole. The biomechanical indices of the donor foot were basically restored to normal six months after operation. Only the stress concentration area centred on the third metatarsal head, and the pain on the forefoot was induced after the operation. Discomfort, callus formation, metatarsal fasciitis, etc. can lead to fatigue fracture of the third metatarsal bone in severe cases, which requires further follow-up and observation.

Conditions

Thumb Injury

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Eligibility Criteria

Inclusion Criteria

1. patients with second-degree thumb defect；

2. without any foot disease or deformity before injury；

3. Written informed consent to undergo the surgical procedure；

Exclusion Criteria

1. Concomitant phalanx fractures or other injuries needing immobilization；

2. Loss of skin substance requiring grafts or flaps

3. Uncompensated diabetes, neoplasia, haemocoagulative alterations, psychic disorders

4. Smokers

• Minimum Eligible Age: 17 Years
• Maximum Eligible Age: 46 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Tangshan Worker's Hospital

OTHER

Sponsor Role: collaborator

The Second Hospital of Tangshan

OTHER

Sponsor Role: collaborator

Hebei Medical University

OTHER

Sponsor Role: lead

Responsible Party

Chunjie Liu

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

References

Foucher G. Second toe-to-finger transfer in hand mutilations. Clin Orthop Relat Res. 1995 May;(314):8-12.

Reference Type: BACKGROUND

PMID: 7634655 (View on PubMed)

Pet MA, Ko JH, Vedder NB. Reconstruction of the traumatized thumb. Plast Reconstr Surg. 2014 Dec;134(6):1235-1245. doi: 10.1097/PRS.0000000000000716.

Reference Type: BACKGROUND

PMID: 25255109 (View on PubMed)

Sabapathy SR, Venkatramani H, Bhardwaj P. Reconstruction of the thumb amputation at the carpometacarpal joint level by groin flap and second toe transfer. Injury. 2013 Mar;44(3):370-5. doi: 10.1016/j.injury.2013.01.012. Epub 2013 Jan 20.

Reference Type: BACKGROUND

PMID: 23340236 (View on PubMed)

Lee KS, Chae IJ, Hahn SB. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe: long-term follow-up of thirty cases. Microsurgery. 1995;16(10):692-7. doi: 10.1002/micr.1920161007.

Reference Type: BACKGROUND

PMID: 8676733 (View on PubMed)

Woo SH, Yoo MJ, Paeng JW. Recent Advances in Immediate Toe-to-Hand Transfer. J Hand Surg Asian Pac Vol. 2016 Oct;21(3):292-9. doi: 10.1142/S2424835516400099.

Reference Type: BACKGROUND

PMID: 27595944 (View on PubMed)

Buldt AK, Allan JJ, Landorf KB, Menz HB. The relationship between foot posture and plantar pressure during walking in adults: A systematic review. Gait Posture. 2018 May;62:56-67. doi: 10.1016/j.gaitpost.2018.02.026. Epub 2018 Feb 23.

Reference Type: BACKGROUND

PMID: 29524798 (View on PubMed)

Liu C, Liu L, Liu G, Tian S, Bai J, Yu K, Tian D. Repair of thumb defect by using the toenail flap: biomechanical analysis of donor foot-a retrospective cohort study. J Orthop Surg Res. 2019 Sep 2;14(1):287. doi: 10.1186/s13018-019-1330-7.

Reference Type: DERIVED

PMID: 31477182 (View on PubMed)

Other Identifiers

2013-01-3

Identifier Type: -

Identifier Source: org_study_id