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Hirase Y, Kanno Y, Okubo A, Onozawa H, Yagishita M, Yamada T. Distal finger reconstruction technique combining a distally-based finger flap and a partial toe flap. Microsurgery 2023; 43:222-228. [PMID: 36367228 DOI: 10.1002/micr.30982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/01/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although aesthetic reconstruction of an amputated distal finger can be achieved through partial toe transfer, this approach often damages the weight-bearing region of the toe from which the flap is harvested. The purpose of this report is to introduce the minimum invasive surgery technique to reconstruct the distal finger aesthetically without damaging the weight-bearing region of the toe. PATIENTS AND METHODS Thirty-one amputated fingertips in 30 patients aged 18 to 68 years were treated using this operative technique. Operations were performed between January 2010 and December 2020. All patients were missing the distal finger beyond the PIP joint, and the amputation stump had been covered with healthy skin. A distally based finger flap was elevated at the recipient site, and a slender partial toe flap, including the nail, was harvested from the great toe. These flaps were combined to form the distal finger. In all cases, the weight-bearing region of the toe remained intact. The donor site wound was first closed with artificial dermis, and skin grafting was performed 3 weeks after the surgery. A few patients did not require skin grafting because their wounds epithelized spontaneously. RESULTS In most patients, the transplanted flap remained healthy and the distal finger was aesthetically restored. Two patients aged over 60 years who were smokers developed necrosis of the transplanted partial toe flap. In all patients, the weight-bearing region of the great toe was intact, and they had no trouble walking during the three-year follow-up period after surgery. CONCLUSION Our technique, which combines elevation of a distally-based finger flap and transplantation of a partial toe flap, was able to minimize the skin defect area in the great toe. This new distal finger reconstruction technique is minimally invasive and can be used to prevent secondary donor site issues.
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Affiliation(s)
- Yuichi Hirase
- Department of Hand Surgery and Microsurgery, Yotsuya Medical Cube, Tokyo, Japan
| | - Yuri Kanno
- Department of Hand Surgery and Microsurgery, Yotsuya Medical Cube, Tokyo, Japan
| | - Arisa Okubo
- Department of Hand Surgery and Microsurgery, Yotsuya Medical Cube, Tokyo, Japan
| | - Hisasuke Onozawa
- Department of Hand Surgery and Microsurgery, Yotsuya Medical Cube, Tokyo, Japan
| | - Mikio Yagishita
- Department of Hand Surgery and Microsurgery, Yotsuya Medical Cube, Tokyo, Japan
| | - Tetsuo Yamada
- Department of Hand Surgery and Microsurgery, Yotsuya Medical Cube, Tokyo, Japan
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Gülgönen A, Gudemez E. Toe-to-Hand Transfers: More Than 20 Years Follow-Up of Five Post-Traumatic Cases. ACTA ACUST UNITED AC 2016; 31:2-8. [PMID: 16298030 DOI: 10.1016/j.jhsb.2005.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Accepted: 09/17/2005] [Indexed: 11/17/2022]
Abstract
In post-traumatic losses of the thumb and fingers, reconstruction can be performed with success using various combinations of toe transfers. In this study, we have presented second toe and combined toe transfers which have been followed up for more than 20 years. Second toe transfer was used in four patients for reconstruction of the thumb. Combined second and third toe transfer was performed in two patients with a metacarpal hand for finger reconstruction. Long-term follow-up results show that patients with toe-to-hand transfers have acceptable adaptation to the reconstructed hand and good hand function. Toe transfer should be individually planned and carefully executed to obtain optimal results and minimal disability in the donor foot.
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Affiliation(s)
- A Gülgönen
- VKV American Hospital, Department of Hand and Microsurgery, Nisantasi, Istanbul, Turkey.
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Venkatramani H, Bhardwaj P, Sierakowski A, Sabapathy SR. Functional outcomes of post-traumatic metacarpal hand reconstruction with free toe-to-hand transfer. Indian J Plast Surg 2016; 49:16-25. [PMID: 27274118 PMCID: PMC4878239 DOI: 10.4103/0970-0358.182232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: We present the functional outcomes of microvascular toe transfer to reconstruct the post-traumatic metacarpal hand deformity. Twelve toe transfers were successfully carried out in 11 patients. Materials and Methods: In each patient, the level of injury was classified according to the Wei classification system. Functional outcome was measured in seven patients using the Tamai score. Additional objective tests of function were carried out in three patients, including the Jebsen test, grip strength, pinch strength, web opening, static and moving two-point discrimination and Semmes–Weinstein monofilament testing. Observation and Results: The average Tamai score was 69 (range 60–83.5). Six patients achieved ‘good’ outcomes and one patient, with a double toe transfer, an ‘excellent’ outcome. The average follow-up time was 43 months (range 10–148 months). Conclusion: This study shows how even a single toe transfer can restore useful function to a hand that has otherwise lost all prehensile ability.
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Affiliation(s)
- Hari Venkatramani
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Praveen Bhardwaj
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Adam Sierakowski
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Raja Sabapathy
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Abstract
BACKGROUND The goals of thumb reconstruction include the restoration of thumb length, strength, position, stability, mobility, sensibility, and aesthetics. It is a rare event when all of these objectives can be achieved, and prioritization should be based on the goals and functional demands of the patient. METHODS In this article, the authors review the most common reconstructive strategies for all types of traumatic thumb defects. RESULTS Replantation is approached first as the primary option for most amputations. Nonreplantable injuries are organized using a simple classification adapted from Lister, dividing thumb amputations into four functional categories: soft-tissue deficit with acceptable length, subtotal amputation with borderline length, total amputation with preservation of the carpometacarpal joint, and total amputation with destruction of the carpometacarpal joint. Within each category, relevant microsurgical and nonmicrosurgical reconstructive techniques are discussed, with a focus on appropriate technique selection for a given patient. Evidence and outcomes data are reviewed where available, and case examples from our own experience are provided. CONCLUSIONS Given that available options now range from simple gauze dressings to complex microsurgical reconstruction, preservation of reconstructive flexibility is essential and should be facilitated by judicious preservation of intact structures. The divergence of available reconstructive pathways underscores the importance of knowing one's patients, understanding their motivation, and assessing their goals. Only in properly matching the right reconstruction with the right patient will a mutually satisfactory result be achieved.
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Abstract
Multiple digital losses will result in crippled hand function and toe transfers are proven to provide replacement of prehensile function. Given that basic hand function requires three factors, viz. an ulnar component, a radial component and opposition, various toe transfers can accomplish thumb ray and ulnar digital defect restoration. Opponensplasty and interpositional suspension arthroplasty can provide circumduction to the thumb component required to perform prehensile functions.
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Affiliation(s)
- Chih-Hung Lin
- Plastic Reconstructive Surgery, Chang-Gung Memorial Hospital and Chang-Gung University, Taoyuan County, Taiwan.
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Manuel Méndez B. Cirugía reconstructiva de la mano. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tsai TM, D'Agostino L, Fang YS, Tien H. Compound flap from the great toe and vascularized joints from the second toe for posttraumatic thumb reconstruction at the level of the proximal metacarpal bone. Microsurgery 2009; 29:178-83. [PMID: 19021229 DOI: 10.1002/micr.20592] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this study is to describe the harvesting technique, anatomic variations, and clinical applications of a compound flap from the great toe and vascularized joint from the second toe used for thumb reconstruction. Five fresh cadaver dissections were studied, focusing attention on the dorsal or plantar vascular dominance, position of the communicating branch between the dorsal and plantar system, the Gilbert classification, and the size of the first dorsal metatarsal artery (FDMA) and first plantar metatarsal artery (FPMA) to the great toe and second toe. Five compound flaps were performed on five patients with traumatic thumb amputation at the level of proximal metacarpal bone. The patients' ages ranged from 14 to 47. Follow-up period was 11-24 months. The anatomic study showed that FPMA had larger caliber in 40% of dissections, FDMA in 40%, and had the same caliber in 20%. The Gilbert classification of FDMA was 40% class I and 60% class III. In the clinical applications, four patients achieved good functional opposition and motion of transferred joints with good pinch and grip strength. There was one flap failure, and donor-site morbidity was minimal. The compound flap offers advantages over traditional toe transfer by providing two functional joints. It can be used for amputation of the thumb at carpometacarpal joint level. Finally, the compound flap maintains growth potential in children through transfer of vascularized epiphyses. The disadvantages of this compound flap include a technically challenging harvest and a longer operative time.
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Affiliation(s)
- Tsu-Min Tsai
- Christine M. Kleinert Institute, Louisville, KY, USA.
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Triple Chimeric Flap Based on Anterior Tibial Vessels for Reconstruction of Severe Traumatic Injuries of the Hand with Thumb Loss. Plast Reconstr Surg 2009; 123:268-275. [DOI: 10.1097/prs.0b013e3181904e10] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Use of the Reversed Posterior Interosseous Flap in Staged Reconstruction of Mutilating Hand Injuries before Toe Transfers. Plast Reconstr Surg 2008; 122:1823-1826. [DOI: 10.1097/prs.0b013e31818cc222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gazarian A, Abrahamyan DO. Allogreffe de main chez le nouveau-né agénésique: étude de faisabilité. ANN CHIR PLAST ESTH 2007; 52:451-8. [PMID: 17688993 DOI: 10.1016/j.anplas.2007.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 05/22/2007] [Indexed: 11/22/2022]
Abstract
Would a newborn with a single hand benefit from hand allograft? Transantebrachial aplasia is the chosen clinical form of agenesia in our interrogation. The feasibility study presents several aspects: 1) ethical and psychological aspects. Is this a desired surgery for agenesic population? Which are the functional, psychological and social situations of agenesic patient? Is the hand transplantation in newborn ethically acceptable? What is the parents' attitude toward agenesia? Can we envisage organ donation in neonatal period? 2) immunological aspects. The non-vital character of this condition and its' good functional tolerance cannot make accepting the risk of adverse effects of hand allotransplantation. Hence, one may consider this surgery only without immunosuppression. Can the peculiarities of the neonate "immature" immune system represent an opportunity of easier tolerance obtaining, avoiding immunosuppression? 3) anatomical and technical aspects. The proximal tissues at the level of amputation are all hypoplastic in agenesic patients. Can we efficaciously suture those structures with donor eutrophic tissues? 4) cognitive aspects. Is a neonate born with only one hand is able to use two? A feasibility study on such a subject needs to take into account all these aspects. This research is useful because, even if hand allograft in agenesic newborn will never be done, the provided information will allow to progress in the vaster domain of composite tissue allotransplantation in perinatology.
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Affiliation(s)
- A Gazarian
- Chirurgie de la main et du membre supérieur, clinique du Parc, hôpital Debrousse, pavillons Tbis (orthopédie pédiatrique) et V (transplantation), hôpital Edouard-Herriot, 86, boulevard des Belges, 69006 Lyon, France.
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Salvage of sensation in a hallux-to-thumb transfer by nerve tube reconstruction. J Hand Surg Am 2006; 31:1495-8. [PMID: 17095380 DOI: 10.1016/j.jhsa.2006.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 07/07/2006] [Accepted: 07/10/2006] [Indexed: 02/02/2023]
Abstract
We report a patient in whom, at 3 years after successful reconstruction of a right avulsed thumb with a microvascular hallux transfer, the insensate transfer had sensibility restored. The radial sensory and both volar digital nerves of the thumb were reconstructed using 2.3-mm-diameter bioabsorbable neural conduits. At 30 months after reconstruction, static 2-point discrimination of the hallux was 4 mm at 14.7 g/mm(2) in this now 42-year-old right-handed man. The cutaneous pressure threshold for 1-point static touch was 0.7 g/mm(2). There were no painful neuromas at the nerve reconstruction sites.
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Ozkan O, Chen HC, Mardini S, Cigna E, Feng GM, Chu YM. Principles for the management of toe-to-hand transfer in reexploration: toe salvage with a tubed groin flap in the last step. Microsurgery 2006; 26:100-5. [PMID: 16538636 DOI: 10.1002/micr.20183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Failure of the transferred toe in toe-to-hand transplantations is a catastrophe and a devastating complication for both the patient and the reconstructive surgeon, as in all microvascular tissue transfers. Management of the toe transfer in the case of reexploration is still a challenging issue, even for experienced microsurgeons. In this report, basic principles for a successful outcome are proposed, based on experience with more than 500 toe-to-hand transfers. Although the requirements for each case may vary, technical details and some basic salvage strategies receive special emphasis. When faced with a problem, the first step should be focused on perceiving the problem differently from under completely normal conditions. The problem may occur at any stage of the procedure. The basic orientations are focused on vasospasm, a thrombus inside the lumen, possible intimal damage that may be caused during the surgery or by a thrombus, or technical failures regarding anastomoses. After all possible revisional procedures have been carried out, if the proper arterial inflow and/or venous outflow are still not provided, or if the general health status of the patient is no longer suitable for additional lengthy procedures, the tubed groin flap can be used to salvage the transferred toe. Between 1996-2004, eight tubed groin flaps were used to salvage transferred toes in the last step of the revisional procedure, with satisfactory results. In conclusion, close follow-up and prompt reexploration when needed are both essential to salvaging transferred toes. Proper surgical strategies and decision-making in reexploration are highly important factors in achieving a successful outcome. In prolonged and recurrent revisional steps, the creation of a tubed flap by means of a reliable flap is an effective procedure as the last step of the salvage procedure.
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Affiliation(s)
- Omer Ozkan
- Department of Plastic and Reconstructive Surgery, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan, R.O.C.
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Abstract
LEARNING OBJECTIVES After reading this article, the reader should be able to: 1. Discuss the critical anatomic features of the thumb as they affect on reconstructive decision making. 2. Define the goals of reconstruction. 3. Discuss an algorithm for thumb reconstruction according to the level of amputation. 4. Understand the role of prosthetics in thumb reconstruction. BACKGROUND The function of the thumb is critical to overall hand function. Uniquely endowed with anatomic features that allow circumduction and opposition, the thumb enables activities of pinch, grasp, and fine manipulation that are essential in daily life. Destruction of the thumb secondary to trauma represents a much more significant loss than would result from loss of any other digit. Therefore, significant effort has been focused on thumb reconstruction. Numerous techniques have been described, ranging from simple osteoplastic techniques to complex microsurgical procedures. With an appreciation of the unique anatomic properties of the thumb, the hand surgeon is better able to understand the goals of thumb reconstruction and to develop an algorithm for thumb reconstruction. With such an understanding, an individualized reconstructive plan can be developed for each patient. METHODS A great many options are available for posttraumatic thumb reconstruction. Optimal results are obtained by pursuing an organized and logical approach to reconstruction based upon the level of tissue loss. Reconstruction methods depend on the location of the amputation and range from homodigital and heterodigital flaps to partial-toe transfer or a great-toe wrap-around flap to first-web-space deepening using Z-plasties, a dorsal rotation flap, or a distant flap, to distraction osteogenesis, lengthening of the thumb ray, spare parts from another injured digit in the acute setting for pollicization or heterotopic replantation, and microvascular toe transfer. RESULTS Amputations in the distal third of the thumb are generally well-tolerated. The primary reconstructive issues are the restoration of a padded and sensate soft-tissue cover, as well as aesthetic considerations. First-web-space deepening will generally provide excellent results for amputations at the distal half of the middle third. In the proximal half of the middle third, lengthening of the thumb ray is generally required. Distraction lengthening of the first metacarpal is a useful and reliable technique that provides up to 3 cm of length without requiring complex microsurgical methods. Spare parts from another injured digit may be used in the acute setting for pollicization or heterotopic replantation. Microvascular toe transfer is an excellent option for elective reconstruction. However, other options also are available and may be more appropriate in some cases. Less ideal options include the various types of osteoplastic reconstruction. CONCLUSIONS The reconstruction of posttraumatic thumb defects is a challenging and rewarding surgical endeavor. The value of a functioning thumb is immense, and its reconstruction is worthy of considerable effort. Despite the elegant reconstructive options available, the best results are obtained with replantation or revascularization whenever possible. Finally, the treatment plan always must be derived from a careful assessment of each patient's posttraumatic function and specific reconstructive needs.
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Affiliation(s)
- Arshad R Muzaffar
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington 98105, USA.
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Wei FC, Coskunfirat OK, Lin CH, Lin YT. Isolated third-toe transfer: indications, technique, and reliability. Plast Reconstr Surg 2005; 115:1314-21; discussion 1322-4. [PMID: 15809592 DOI: 10.1097/01.prs.0000156975.47263.ca] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Isolated third-toe transfer is a versatile and safe technique when indicated. METHODS Between January of 1984 and January of 2003, 37 isolated third-toe transfers were performed in 31 patients. RESULTS Only one partial loss was noted among 37 transfers. There were 24 male and seven female patients, with an average age of 27.4 years (range, 7 to 43 years). Twenty-five patients received additional toe transfers. Secondary surgery was performed in 17 toes of 15 patients to improve the functional and cosmetic results. Patients were followed for 2 to 180 months (average, 36 months) and no significant donor-site morbidity was seen. CONCLUSIONS Basically, the indications for isolated third-toe transfer are evaluated in two groups. Third-toe transfer is absolutely indicated when it is necessary for restoring basic hand functions in multiple-finger amputations. It is indicated because both second toes are transferred or the remaining second toe is adjacent to the previously transferred great toe. The other absolute indication is the unavailability of second toes because of trauma or deformity. Third-toe transfer is indicated relatively if it is used for additional reconstruction when basic hand functions are regained or already exist. Another relative indication is its better size match for proposed reconstruction. Second and third dorsal and plantar metatarsal arteries can be used as the pedicle artery for third toe-transfer; however, if second-toe transfer has already been performed or is planned, the third plantar or dorsal metatarsal artery should be used. Isolated third-toe transfer is a useful and reliable technique, especially in multiple-finger amputation reconstruction.
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Affiliation(s)
- Fu-Chan Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Medical College, Chang Gung University, Taipei, Taiwan.
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Coskunfirat OK, Wei FC, Lin CH, Chen HC, Lin YT. Simultaneous Double Second Toe Transfer for Reconstruction of Adjacent Fingers. Plast Reconstr Surg 2005; 115:1064-9. [PMID: 15793447 DOI: 10.1097/01.prs.0000156144.86563.a9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors reviewed their results with simultaneous double second toe transfer for reconstruction of adjacent fingers. METHODS From January of 1984 to January of 2003, simultaneous double second toe transfer was performed for reconstruction of adjacent fingers in 140 patients (48 before wound closure, 92 after). Functional thumbs were present in all of them. There were 104 male and 36 female patients, with an average age of 29.1 years (range, 2 to 57 years). Index and middle fingers were reconstructed in 90 patients, middle and ring fingers in 49 patients, and ring and little fingers in one patient. The average operation time was 11 hours 25 minutes, which was much shorter than double the average time of a single second toe transfer (8 hours 31 minutes; double time, 17 hours 2 minutes). Twenty-six toes were reexplored for vascular insufficiency and three of them were lost. Secondary surgery was performed in 98 patients to improve function and cosmesis. RESULTS Patients were followed up at an average period of 47.5 months (range, 2 to 210 months). Forty-two patients had complete functional evaluation at a minimum 2-year follow-up. The mean active range of motion of the reconstructed finger joints in these patients was 69.4 degrees for metacarpophalangeal joints, 31.1 degrees for proximal interphalangeal joints, and 8.2 degrees for distal interphalangeal joints. Two-point discrimination was between 3 and 13 mm (average, 7.5 mm). All donor sites were closed primarily and no obvious donor-site morbidity was noted, except for one hallux valgus deformity that was corrected by surgery. CONCLUSIONS The functional and aesthetic results of double second toe transfers for adjacent two-finger reconstruction are superior to those of a single second toe-to-single finger reconstruction in multiple-finger amputations. Double second toe transfer performed simultaneously reduces the cost and total time of the operation, enables faster rehabilitation, and hastens patient adaptation.
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Affiliation(s)
- O Koray Coskunfirat
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Medical College, Chang Gung University, Taipei, Taiwan
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Maloney CT, DeJesus R, Dellon AL. Painful foot neuromas after toe-to-thumb transfer. J Hand Surg Am 2005; 30:105-10. [PMID: 15680564 DOI: 10.1016/j.jhsa.2004.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 09/21/2004] [Indexed: 02/02/2023]
Abstract
Reconstruction of the thumb by transfer of a toe has evolved technically to the point that this complex procedure can result in a mobile, sensate, and aesthetically pleasing digit that contributes to an almost-normally functioning hand. Donor site deformity is well recognized, primarily as it relates to the appearance of the foot after transfer of the hallux to the thumb position and stiffness of the remaining portions of the big toe. The present report describes donor site disability related to painful neuromas of the superficial and deep peroneal nerves and the common plantar digital nerve to the first webspace. Salvage of the disabled donor foot is possible by applying techniques used to treat painful neuromas of the upper extremity, neuroma resection, and muscle implantation. The specific techniques used in treating this painful foot donor site after toe-to-thumb transfer are described.
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Affiliation(s)
- Christopher T Maloney
- Department of Surgery and Orthopedic Surgery, University of Arizona, Tucson, AZ, USA
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