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9.2 Common Rehabilitation Methods
123
Fig. 9.13 Autonomic exercises
Fig. 9.14 Writing exercises Fig. 9.15 Griping exercise
124
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9 Functional Rehabilitation forFinger Reconstruction
Fig. 9.16 Pinch, holding function exercise
Fig. 9.17 Extension and exion function exercise of ngers by using
the mouse
the mechanical axis consistent with the axis of joint
movement; (4) Intrinsic hand muscles training: There
are only a few methods of training for intrinsic hand
muscles which are presented by the ball and the rub-
ber band net that can exercise the extensor, exor,
and all the intrinsic hand muscles.
Attention for muscle function exercise: (1) The method
should be selected according to the condition of
patients and equipment, and corresponding changes
should be made with diseases; (2) The size of exercise should be proper.
(c) Full-body exercise: From the point of biology, human
being is a kind of higher animal which has a high
dependence on muscle movement in the process of
its race and individual development. Lack of exercise, especially because of injury in bed, can cause a
series of adverse reaction, such as changes in cardiopulmonary function, muscle atrophy, lack of appetite, decreased immunity and the ability of adapt,
depressed mood, and various laid-in-bed complications––pneumonia, pressure sores, deep vein thrombosis, urinary tract infection which would be life
threatening when it is serious but it can be prevented
by following measures: (1) Finger reconstruction is
upper limb injury, and there is no need to stay in bed
9.2 Common Rehabilitation Methods
Fig. 9.18 Chinese medicine rehabilitation exercise
125
Fig. 9.19 Plantar function exercise
Fig. 9.20 Arch rehabilitation
exercises
126
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9 Functional Rehabilitation forFinger Reconstruction
Fig. 9.21 Foot stress exercise
Fig. 9.22 The great toe function exercise
except the rst week after surgery; (2) Healthy exercise in the bed, including deep breath, active movement of uninjured limbs, chest, and waist, etc., which
can be carried out collectively, and including routing
nursing; (3) Aerobic exercise, including walking,
jogging, walking up and down stairs, and exercise
with the help of equipment.
(d) Sensory exercise: (1) Sensory reeducation: The
patients should be educated not to touch sharp or hot
Fig. 9.23 CPM function exercise
9.4 The Signicance ofFunctional Rehabilitation
Fig. 9.24 Foot and ankle function exercise
objects with ngers; (2) Tactile stimulation: To
restore the sense of stillness, eye should be kept open
and the skin around the affected nger should be
pressed with a rubber cylinder at the appropriate
pressure, and then eye should be kept close to feel the
difference; (3) Temperature sensory exercise: The
difference between opening eyes and closing eyes
should be felt when touching the cold and warm bottles with the affected nger, 10 min each time, 2
times/day; (4) Compound sensory exercise: Glass
marbles, small wooden blocks, red dates, hexagonal
nuts, rubber, peanuts, screws, sandpaper, and coins
are embedded in rice to test whether the patients
could correctly judge the objects they are touching.
3. Occupational therapy: Occupational therapy is an important part of rehabilitation treatment, and it is also a link
between patients’ families and the society. Occupational
therapy is a bridge form hospitals to the society for
patients, including the ability of self-care, the ability to
create value in the professional work, and recreational
activities which should meet following demands: (1)
Purposeful and meaningful activities; (2) Have appropriate difculty to play a training role; (3) It can be achieved
through efforts of patients; (4) Be interesting; (5) The
amount of activity can be adjusted.
4. Application of braces: Braces, also known as orthopedic
devices, are used to assist or treat motor organs with the
help of external mechanical structures which can be relatively or strictly immobilized to ensure tissue healing, antiinammatory, and pain relief, and facilitate movements of
other joints, creating conditions for early movements of the
entire limb, continuous correction of some malformed
joints or deformity prevention. With the development of
the times, the braces are made more and more beautiful,
127
light, comfortable and can be washed and removed conveniently which is easy to be accepted by public.
5. Occupational rehabilitation: the patients’ occupation
should be obtained and the job demand should be analyzed.
Corresponding pre-job training should be conducted based
on the patients’ functional conditions and job requirements. To restore the nger function and self- care ability as
maximum as possible, the disabled workers’ professional
ability should be improved as far as possible so as to promote them to fully return to work and the society.
6. Chinese traditional rehabilitation: Based on the basic
theory traditional Chinese medicine, the patient will
recover according to syndromes differentiation according
to the pathological characteristics of diseases, disabilities, and other syndromes by using acupuncture, massage,
traditional sports, qigong, diet, nature, traditional physics, and entertainment.
7. Psychological counseling: Psychological methods for sleep,
pain, and emotional management to promote communication and improve patient compliance and condence.
8. Rehabilitation robot: Rehabilitation robot is a combination of industrial robot and medical robot. At present, the
research mainly focuses on rehabilitation manipulator,
hospital robot system, intelligent wheelchair, articial
limb, and rehabilitation robot. It mainly uses the new articial intelligence technology to complete the regular passive movement of different degrees to replace articial
rehabilitation activities which has a certain regularity,
persistence, unity, convenience, but lack of exibility and
practicality (high cost) that is not yet widely available.
9.3 Rehabilitation Features ofFinger
Reconstruction
Compared with the exercise after nger replantation, the
requirements of postoperative rehabilitation are more strict
and complex, because the blood supply may be unstable in the
early stage after surgery, and other complications may occur,
otherwise, the rehabilitation of lower limb in donor site should
also be considered which focuses on the normal life functions
of the affected nger, including the improvement of nger
exibility, grip strength, pinch strength, the enhancement of
endurance, the recovery of functional touch, as well as the
lower limbs walking, squatting, sitting, lying, and standing.
9.4 The Signicance ofFunctional
Rehabilitation
The hand is not only an important organ of labor but also an
important organ of expression. The purpose of thumb and
nger reconstruction is not only to improve the appearance
128
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9 Functional Rehabilitation forFinger Reconstruction
but also to recover the function. In a word, because of the
particularity of the patients with severed ngers and the particularity of hands in human organs, once the function is lost,
it is likely to cause a family’s dilemma and increase the
social burden. However, nger reconstruction only creates
the necessary conditions and foundation for the recovery of
hand function. In order to achieve good function, systematic
and standard physical rehabilitation therapy is essential.
Figures of commonly used hand function rehabilita-
tion (Figs.9.1, 9.2, 9.3, 9.4, 9.5, 9.6, 9.7, 9.8, 9.9, 9.10, 9.11,
9.12, 9.13, 9.14, 9.15, 9.16, 9.17, and 9.18).
Commonly methods for foot function rehabilitation
exercise (reproduced with permission from https://image.
baidu.com/search/index?tn=baiduimage&ipn=r&ct=201
326592&cl=2&lm=- 1&st=- 1&fm=result&fr=&sf=1&fm
q=1664518974649_R&pv=&ic=0&nc=1&z=&hd=&lates
t=©right=&se=1&showtab=0&fb=0&width=&heig
ht=&face=0&istype=2&dyTabStr=&ie=utf- 8&sid=&wo
rd=%E8%B6%B3%E5%BA%B7%E5%A4%8D)
(Figs.9.19, 9.20, 9.21, 9.22, 9.23, and 9.24).
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Part II
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Dierent Types of Finger Reconstruction
Reconstruction ofThumb Defects
10
Abstract
Since the successful operation of thumb reconstruction
with free second toe transplantation in 1966, toe trans-
plantation has been widely used to reconstruct thumb and
ngers, and obtained good clinical effects. Due to various
factors, many patients and doctors are not very satised
with the reconstructed ngers. In order to make the recon-
structed nger as close as possible to the shape and func-
tion of the nger. Hand microsurgeons have done a lot of
work to improve the appearance and function of toes.
With continuous in-depth research, a number of improve-
ments and innovations have been made in the reconstruc-
tion techniques and methods, and the surgical methods
have been continuously developed from extensive to
detailed, so that nger reconstruction with free second toe
transplantation has been continuously improved.
Keywords
Finger reconstruction · Thumb defect
patients with type I defect of thumb need repair and reconstruction. Considering the psychological, occupational, aesthetic, and social needs of the patients, reconstruction of the
terminal segment of the thumb with anastomotic toe-nger
arteriovenous blood circulation can be adopted to obtain satisfactory appearance and function. There are many types of
injuries to the terminal segment of the thumb, including terminal segment defect, nger pulp defect, nail defect, and
degloving injury. Commonly used methods are partial great
toe transplantation and second toe transplantation.
10.1.1 Indications
(1) Adult, young, and middle-aged is better; (2) No basic disease, mental disease, peripheral vascular disease; (3) Type I
defect of thumb; (4) The patient has a strong desire for
reconstruction; (5) The wound is clean and the surrounding
tissues are free from infection; (6) There is no history of
trauma, surgery, or infection in the donor toe and the appearance is normal.
10.1 Reconstruction ofType IDefect
10.1.2 Surgical Design
oftheThumb
The main purpose of the reconstruction of Type I defect of
Finger is the most exible organ of the human body, hand
trauma is common, which is a very painful thing, not only
affects the quality of life of patients but also makes patients
have inferiority complex. The thumb accounts for about 40%
of the function of the hand and the defect of the thumb will
seriously affect the function of the hand. The traditional view
is that type I defect will lose 20–30% of the function of the
thumb and about 10% of the function of the side hand which
cannot to be reconstructed. However, with the development
of society and economy, people are paying more and more
attention to the pursuit of appearance beauty on the basis of
satisfying their material needs, and there are more and more
© Springer Nature Singapore Pte Ltd. 2023
J. Lin et al., Atlas of Finger Reconstruction, https://doi.org/10.1007/978-981-19-9612-2_10
thumb is to look beautiful, and the selection of the donor toe
is mainly to consider the matching of the shape of the defect
and the shape of the toe. Commonly used reconstructive
techniques include partial great toe grafts and partial second
toe grafts, and the terminal great toe is usually preferred as
the donor site. The transplant length should be based on the
normal thumb length, and it is better to be short than long.
1. Incision design in the recipient site: (a) If a rst-stage
emergency reconstruction is performed on a patient with
open injury. A complete debridement should be performed on the stump, and the irregular and redundant
133
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10 Reconstruction ofThumb Defects
skin should be temporarily retained; (b) If reconstruction
is elective, since the thumb stump is thick, ring or coronal
incision should be made at the stump (Fig.10.1). After
the skin is lifted to the dorsal palmar, the skin should be
properly trimmed.
An oblique incision should be made on the dorsal
proximal segment of the thumb to expose the dorsal digital vein and on the ulnar side of the thumb to expose the
proper ulnar digital artery or the principal artery of
thumb.
2. Incision design in the donor site: The terminal segment of
great toe graft should be selected, and the skin incision
should be designed according to the length of the thumb
defect and the skin and soft tissue conditions at the residual end (Fig.10.2).
A ring incision should be designed at 1cm posterior to
the toenail fold as the furthest end, the plantar side can do
different plane design according to the defect degree, and
a lingual ap about 14–17mm wide on the tibial side of
the great toe is retained from the root and gradually converges toward the toe end and across the midline.
Fig. 10.1 Incision design of thumb stump
10.1.3 Surgical Method
The patient should have complete preoperative examinations
without contraindications to surgery and anesthesia, and is
carried out under general anesthesia in the operating room.
Preparation fortheRecipient Site
Coronal incision is made at the stump, scar should be
removed, and the skin is lifted to the dorsum. The proper
digital nerves and the principal arteries of thumb should be
marked on both sides. An arc incision is made on the dorsal
proximal segment to separate one or two thicker dorsal phalanx veins for use.
Fig. 10.2 Incision design in the donor site
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