1. Pedicled Adipose Tissue for Treatment of Chronic Digital Osteomyelitis
Mitsuhiro Okada, MD, PhD, Masayuki Kamano, MD, PhD, Takuya Uemura, MD, PhD, Mikinori Ikeda, MD, Hiroaki Nakamura, MD, PhD 
Journal of Hand Surgery 
Volume 40, Issue 4, Pages (April 2015)
DOI: /j.jhsa
Copyright © 2015 American Society for Surgery of the Hand Terms and Conditions

2. Figure 1
Surgical technique. A Retrograde-flow pedicled adipose tissue transfer for chronic osteomyelitis of the distal phalanx. Retrograde adipose tissue nourished by the digital artery is elevated, leaving the digital nerve undamaged. B Retrograde-flow pedicled adipose tissue is inserted into the dead space after debridement of chronic osteomyelitis of the distal phalanx. C Anterograde-flow pedicled adipose tissue transfer for chronic osteomyelitis of the proximal phalanx. Anterograde adipose tissue nourished by the digital artery is elevated, leaving the digital nerve undamaged. D Anterograde-flow pedicled adipose tissue is inserted into the dead space after debridement of chronic osteomyelitis of the proximal phalanx. P, pedicled adipose tissue based on the digital artery; N, digital nerve.
Journal of Hand Surgery  , DOI: ( /j.jhsa )
Copyright © 2015 American Society for Surgery of the Hand Terms and Conditions

3. Figure 2
Preoperative and postoperative posterior–anterior plain radiographs of case 4. A Preoperative radiograph showing osteolysis of the distal and middle phalanges around the DIP joint and destruction of the DIP joint. B Postoperative radiograph showing fusion of the DIP joint. Asterisk, bony window; arrowheads, debrided bone marrow cavity distal to the middle phalanx across the DIP joint for the pedicled adipose tissue.
Journal of Hand Surgery  , DOI: ( /j.jhsa )
Copyright © 2015 American Society for Surgery of the Hand Terms and Conditions

4. Figure 3
Intraoperative photographs of case 4. A Pedicled adipose tissue nourished by the digital artery with retrograde flow. B Pedicled adipose tissue is pulled from the bony window toward the fingertip across the DIP joint. P, pedicled adipose tissue nourished by the digital artery; DA, digital artery; N, digital nerve.
Journal of Hand Surgery  , DOI: ( /j.jhsa )
Copyright © 2015 American Society for Surgery of the Hand Terms and Conditions

5. Figure 4
Preoperative images of case 7. A Defect and osteolytic change of the distal phalanx is present on a posterior–anterior plain radiograph. B Coronal T2-weighted, fat-suppressed MRI showing high signal intensity in the bone marrow of the distal phalanx and high intensity in the area of the bone defect, implying pus collection (arrow).
Journal of Hand Surgery  , DOI: ( /j.jhsa )
Copyright © 2015 American Society for Surgery of the Hand Terms and Conditions

6. Figure 5
Postoperative images of case 7. A Coronal T1-weighted MRI 24 months after surgery showing viability of the pedicled adipose tissue (circle) inserted into the dead space after debridement and restoration of normal signal intensity within the bone marrow of the distal phalanx. B Coronal T2-weighted, fat-suppressed MRI showing restoration of normal signal intensity within the bone marrow of the distal phalanx.
Journal of Hand Surgery  , DOI: ( /j.jhsa )
Copyright © 2015 American Society for Surgery of the Hand Terms and Conditions