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Background Conventional angiography is an invasive technique. Submillimeter computed tomography angiography (CTA) has been shown to be an effective alternative for peripheral artery branches. This study aimed to assess the use of CTA to guide the choice and design of foot donor area for finger or thumb reconstruction. Methods This was a retrospective study of 79 patients who underwent finger or thumb reconstruction between January, 2011 and March, 2014. All these patients underwent preoperative CTA to determine the exact blood supply at the donor site. Preoperative imaging and intraoperative findings at the donor site were compared. Results Among the 79 patients (158 feet), 474 artery segments (dorsalis pedis artery [DPA], first dorsal metatarsal artery [FDMA], and toe web artery [TWA]) were evaluated using CTA. Image satisfaction rates of the vessels were 100.0 ± 0.0%, 89.2 ± 3.2%, and 60.1 ± 5.0% for DPA, FDMA, and TWA, respectively. Among the 158 feet, 90 were Gilbert type I (57.0%), 52 were Gilbert type II (32.9%), 13 were Gilbert type III (8.2%), and 3 were with poor visibility and could not be classified (1.9%). In all 79 patients, the CTA image of the FDMA was consistent with the intraoperative observations. All reconstructed fingers survived. Follow-up was available for 69 patients. After a 6- to 18-month follow-up, the reconstructed fingers and donor area recovered well, and the reconstructed fingers had strong holding power, without pain. Conclusion CTA can produce three-dimensional images for extremity arteries, allowing the preoperative assessment of blood supply and planning of donor site. [ABSTRACT FROM AUTHOR]

Background Microsurgical toe-to-hand transplantation is a reasonable salvage procedure after failed replantation, though no consensus exists on proper donor toe length for restoration of hand function and optimal donor flap needed for recipient site healing. The purpose of this study was to introduce a novel technique for preoperative planning in complicated toe-to-hand reconstruction and to assess feasibility in four cases. Methods Computed tomography (CT) angiography was used to map donor site vasculature, whereas CT data were used to create three-dimensional (3D) soft tissue and skeletal models for injured and uninjured hands. Based on the reformatted model (mirror of uninjured hand), soft tissue and finger skeletonmodels were generated using a 3D printer. An adhesive plaster model was placed on the donor site to determine osteotomy level and incision markings. The skeletal model was used to determine the length of the donor foot resection. Four complex amputation cases were included to illustrate clinical feasibility and early functional and cosmetic outcomes. Results In all four cases, thumb and fingers were reconstructed successfully and all flaps survived. No arterial or venous thrombosis or major donor morbidity were observed. Functional and cosmetic outcomes were satisfactory with similarly satisfactory static two-point discrimination, key pinch and grip strength, and Michigan Hand Outcomes Questionnaire scores. Conclusion This novel microsurgical toe-to-hand reconstruction methodology, as introduced in this study, showed promising functional and cosmetic outcomes. Application of this technique in complex hand injuries has the potential to increase surgical efficiency, minimize procedural morbidity, and improve reproducibility. [ABSTRACT FROM AUTHOR]