Reconstruction of the subungual region for tumors of the thumb: Outcomes of the reverse, dorsoulnar flap.
Bibliographic record
Abstract
Background For subungual, malignant skin tumors of the thumb, ultimate treatment has mostly been the amputation, a procedure that comes with a significant functional loss. We propose reconstruction of the defect with the reverse, homodigital, dorsoulnar, pedicled (RHDU) flap, if no osseous infiltration is present.Methods We present the cosmetic and functional results in five patients treated for subungual tumors of the thumb between May 2020 and September 2023. Range of motion in the metacarpo-and interphalangeal joints, the widening angle of the first web, Kapandji score, grip and pinch strength, outcome scores including the disability of the arm, shoulder and hand (DASH) and Michigan Hand Score (MHQ) were assessed at final follow up.Results Range for follow up was 1-5 years. Function was comparable to the contralateral side. Patient reported outcome showed satisfactory function with an average DASH score of 12.82 and MHQ score of 84.8. The cosmetic result was rated with an average of 90 points on the visual analogue scale for cosmesis. No recurrence of the tumor has been reported in any case.Conclusion Reconstruction of the defect with a RHDU flap after excision of subungual tumors and proof of no osseous invasion, is a reliable and a promising alternative to an amputation, resulting in satisfactory functional and cosmetic outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".