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Yoon AP, Jones NF. Long-term Outcomes after Toe-To-Thumb Transfers for Burn Reconstruction in Children. J Burn Care Res 2021; 43:440-444. [PMID: 34089608 DOI: 10.1093/jbcr/irab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Children are one of the most vulnerable populations to burns, and hands are frequently burned anatomical structures. Restoring function in a severely burned pediatric hand is challenging. We present our experience with pediatric toe-to-thumb transfers for burn reconstruction. A retrospective review was conducted of all pediatric toe-to-thumb transfer patients between 2009 and 2014. Children under the age of 18 who underwent secondary reconstruction after electrical or thermal burn injuries with at least 5-year follow-up were included. Functional outcomes were measured with the modified Kapandji score. Complications of the reconstructed hand as well as donor foot were recorded. Four children with 10 toe-to-hand transfers (4 great toes, 2 second toes, and 2 combined second-third toes) met the inclusion criteria. Average follow-up length was 104 months (range 60-144 months) Two children sustained thermal burn injuries and two sustained electrical burn injuries. Three children achieved opposition of the reconstructed toe-to-thumb transfer to the small finger (Kapandji score 5), and one child achieved opposition of the reconstructed toe-to-thumb transfer to the proximal phalanx of the middle finger, the only remaining finger (Kapandji score 3). No donor foot morbidities were noted postoperatively. Toe-to-thumb transfers should be considered the gold standard for thumb reconstruction in children with severe burn injuries of their hands and provide restoration of sensation, pinch, grasp and opposition with minimal morbidity of the donor foot.
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Affiliation(s)
- Alfred P Yoon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI. Taubman Center, East Medical Center Drive, Ann Arbor, MI
| | - Neil F Jones
- Department of Orthopedic Surgery and Division of Plastic Surgery, University of California Los Angeles, Los Angeles, CA, UCLA Medical Plaza Suite, Los Angeles, CA
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Lombard J, Steiger C, Dautel G. Our surgical technique to treat premature growth plate closure 7 years after toe-to-thumb transfer. A case report. HAND SURGERY & REHABILITATION 2020; 39:131-135. [PMID: 31982593 DOI: 10.1016/j.hansur.2019.10.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 11/26/2022]
Abstract
In children, traumatic distal amputations of the thumb can be treated by partial first toe transfer. Growth is preserved by conserving a portion of the growth plate in the hallux distal phalanx. In the patient featured here, 7 years after such a distal thumb reconstruction, bone bridge resection was needed to restart growth and correct clinodactyly. When this patient was reviewed 4 years later, the thumb's longitudinal growth had been restored and continued.
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Affiliation(s)
- J Lombard
- Chirurgie reconstructrice et esthétique de l'appareil locomoteur, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - C Steiger
- Department of pediatrics orthopaedic surgery, hôpitaux universitaires de Genève, rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - G Dautel
- Chirurgie reconstructrice et esthétique de l'appareil locomoteur, centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
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Thumb Amputations in Children: Classification and Reconstruction by Microsurgical Toe Transfers. J Hand Surg Am 2019; 44:519.e1-519.e10. [PMID: 30292715 DOI: 10.1016/j.jhsa.2018.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 07/08/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Traumatic amputations of the thumb are rare in children compared with adults, but hand surgeons remain reticent to consider microsurgical reconstruction with toe-to-thumb transfers. This study reports the functional outcomes and complications of children with traumatic thumb amputations who underwent toe-to-thumb reconstruction. METHODS A retrospective review of children who sustained thumb amputations and whose parents elected for their child to undergo reconstruction by toe-to-thumb transfer was performed. Details of the level of thumb amputation, whether other fingers were also amputated, which toe was transferred on which vascular pedicle, survival of the transfer, and complications, were collected. Opposition, sensation, and growth of the toe-to-thumb transfers was measured. Functional and psychosocial outcomes were evaluated by both the parents and the older children using the Pediatric Outcomes Data Collection Instrument questionnaire. RESULTS Twenty-one thumb amputations in 19 children between the ages of 2 and 17 years were referred for secondary reconstruction. Ten were isolated thumb amputations and 11 were combined thumb and multiple finger amputations. Two children had bilateral thumb amputations. Twenty-one toe-to-thumb transfers were performed: 14 second toe transfers and 7 great toe transfers (3 great toe and 2 trimmed and 2 Morrison wraparound variations). There were no immediate postoperative reexplorations of the microsurgical anastomoses and all toe transfers survived completely. All children regained pinch and grasp function and sensation. There were no gait problems in the donor feet. CONCLUSIONS Microsurgical toe-to-thumb transfers should be offered as an alternative option to the traditional techniques of distraction lengthening and pollicization, for posttraumatic thumb reconstruction in children for any level of amputation from just distal to the carpometacarpal joint to the interphalangeal joint. Toe-to-thumb transfer provides length, opposition, and sensation without disturbing ambulation and is associated with excellent psychosocial outcomes as evaluated by both parents and older children. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Bachleitner K, Blank B, Klein S, Geis S, Aung T, Prantl L, Dolderer JH. Vascularized transfer of two coherent toe joints in simultaneously reconstructing MCP and PIP of a mutilated finger. Clin Hemorheol Microcirc 2017; 64:333-344. [PMID: 28128750 DOI: 10.3233/ch-168100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The reconstruction of metacarpal- and interphalangeal joints after severe hand injuries has been proven to be challenging. Commonly used procedures like arthrodesis, amputation or ray resection of the finger compromise the functionality of the injured finger. Especially for young patients, the restoration of all functions of the fingers is a priority. Local tissue transfers for finger joint reconstructions is not an option due to inacceptable donor site morbidity; microsurgical tissue transfers in terms of free toe joint transfers have proven to be a valuable method. METHODS We present the case of a patient who suffered an excessive injury from a circular saw to his dominant hand. The MCP Joints of D2-D4 were fully destroyed, along with the PIP joint of a subtotally amputated D4. Arteries, nerves and tendons could be coapted directly, while primarily reconstructing of the finger joints was impossible. To ensure a possible regain of full functionality, two coherent joints, the MTP and the PIP of one toe, were transferred to the ring finger as a single transplant, reconstructing the MCP and the PIP joints of the injured finger in a one step procedure. Additionally the MCP joint of the D2 was reconstructed by the use of a free PIP-joint transfer, further the MCP joint of the D3 was replaced by an MCP endoprosthesis. RESULTS After a follow up of 3 years the patient displayed full function of his dominant hand including sensitivity, and has gone back to manual work without limitations. The result was cosmetically acceptable and the donor site defect was easily being tolerated by the patient who is playing soccer in the regional soccer league. CONCLUSION Free double toe joint transfer has been proven feasible in this patient. While transferring a single toe joint to reconstruct a finger joint is a well-established method, our review of the latest literature showed no case of a free transfer of two coherent joints and three transplanted joints in one hand. The applied microsurgical technique should be considered by microsurgically trained hand surgeons for the treatment of comparable severe hand injuries. In comparison to the most common procedures described for the repair and reconstruction of severely injured finger joints this method showed superior results.
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Affiliation(s)
- K Bachleitner
- Department of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - B Blank
- Department of Plastic-, Reconstructive- und Hand Surgery, Burn Center, University Hospital of Paracelsus Medical Private University Nuernberg, Germany
| | - S Klein
- Department of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Geis
- Department of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - T Aung
- Department of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L Prantl
- Department of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J H Dolderer
- Department of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Hu R, Ren YJ, Yan L, Xiao ZH, Ding F, Li F, Han Q, Cheng WJ, Kan WS. A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles. Injury 2015. [PMID: 26206164 DOI: 10.1016/j.injury.2015.06.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE High-energy injury to children caused by a traffic accident is usually characterised by extensive soft tissue defects with exposure or loss of tendons and bone at the foot. Segmental loss of the Achilles tendon along with soft tissue defects is a great challenge for microsurgical reconstruction. Free anterolateral thigh (ALT) flap is indicated for reconstruction of such defects because limited local tissues are available. Additionally, iliotibial band in the donor area can be used to reconstruct the damaged tendon. MATERIALS AND METHODS Here we described our successful management of 25 paediatric patients with such high-energy injury at feet and ankles in one-stage transplantation of a free ALT flap and an iliotibial band from January 2008 to January 2013. The tendon defect, ranging from 3 to 16cm in length, was reconstructed with an iliotibial band. The flaps ranged from 5 to 12cm in width and 8 to 18cm in length. RESULTS All the flaps survived completely and no donor site complications were observed. In two flaps there was a small area of distal necrosis which was healed by dressing changes. The mean follow-up time was 14.2 months (from 6 to 24 months). Limb function was assessed using the Maryland Foot Score. The excellent and good rate was 92%. CONCLUSIONS We believe a free ALT flap is ideal for reconstruction of massive soft tissue defects at the foot and ankle in children and an iliotibial band from the same donor site can be used for reconstruction of a damaged tendon.
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Affiliation(s)
- Rui Hu
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Yi-Jun Ren
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China.
| | - Li Yan
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Zhi-Hong Xiao
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Fan Ding
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Fan Li
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Qiong Han
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Wen-Jun Cheng
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Wu-Sheng Kan
- Department of Reparative and Reconstructive Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
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Bourke G. Amputations, replantation and thumb reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Second-toe transfer for traumatic thumb amputation in children under 5 years: bone and soft-tissue growth. Tech Hand Up Extrem Surg 2014; 18:175-80. [PMID: 25144356 DOI: 10.1097/bth.0000000000000063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic thumb amputations in children under 5 years are uncommon. The final clinical long-term results have been reported shortly in literature. We report our clinical experience in children under 5 years with traumatic amputation of the thumb that were reconstructed using a second-toe transfer. MATERIALS AND METHODS There were 7 boys and 2 girls between the ages of 1 and 5 years. The follow-up was between 6 and 14 years. The average age at the time of transfer was 2.8 years, and the average follow-up was 10.7 years (range, between 6 and 14 y). The most frequent cause of amputation was avulsion (33.3%). RESULTS All the transferred toes survived and achieved bone union and static 2-point discrimination was averaged at 5 mm. They acquired good prehensile pinch and grasp. All of the structures of the transferred toes showed substantial growth. CONCLUSIONS Second-toe transfer for traumatic amputation of the thumb continues to be one of the best choices. Children require secondary procedures less often and in some cases late functional recovery can be expected. It is a safe procedure and there are fewer complications and a better success rate.
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Akita S, Mitsukawa N, Rikihisa N, Kuriyama M, Kubota Y, Hasegawa M, Koizumi T, Ishigaki T, Uchida Y, Satoh K. Reconstruction of the great toe using a pedicled medial plantar flap with anterograde venous drainage. Microsurgery 2014; 34:398-403. [DOI: 10.1002/micr.22234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/17/2014] [Accepted: 01/24/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Shinsuke Akita
- Department of Plastic and Reconstructive Surgery; Chiba Cancer Center; Chiba City Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery; Chiba University, Faculty of Medicine; Chiba City Japan
| | - Naoaki Rikihisa
- Department of Plastic and Reconstructive Surgery; Chiba Rosai Hospital; Chiba City Japan
| | - Motone Kuriyama
- Department of Plastic and Reconstructive Surgery; Kochi Medical School Hospital; Nankoku City Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery; Chiba University, Faculty of Medicine; Chiba City Japan
| | - Masakazu Hasegawa
- Department of Plastic, Reconstructive and Aesthetic Surgery; Chiba University, Faculty of Medicine; Chiba City Japan
| | - Tomoe Koizumi
- Department of Plastic, Reconstructive and Aesthetic Surgery; Chiba University, Faculty of Medicine; Chiba City Japan
| | - Tatsuya Ishigaki
- Department of Plastic and Reconstructive Surgery; Chiba Cancer Center; Chiba City Japan
| | - Yuuki Uchida
- Department of Plastic, Reconstructive and Aesthetic Surgery; Chiba University, Faculty of Medicine; Chiba City Japan
| | - Kaneshige Satoh
- Department of Plastic, Reconstructive and Aesthetic Surgery; Chiba University, Faculty of Medicine; Chiba City Japan
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Jones NF, Kaplan J. Indications for microsurgical reconstruction of congenital hand anomalies by toe-to-hand transfers. Hand (N Y) 2013; 8:367-74. [PMID: 24426951 PMCID: PMC3840749 DOI: 10.1007/s11552-013-9534-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The indications for microsurgical toe-to-hand transfers in congenital hand surgery have not been defined as clearly as for posttraumatic reconstruction of thumb and finger amputations. The purpose of this study was to develop simple guidelines for referral of children with congenital absent digits for consideration of microsurgical reconstruction with toe-to-hand transfers, based on the morphological or radiographic anatomy of the hand anomaly, not on embryological classifications. METHODS From a consecutive series of 204 children referred with congenital absence of the thumb and fingers, 100 toe-to-hand transfers were performed. The indications for microsurgical reconstruction of these children were analyzed retrospectively. RESULTS Forty-one thumbs were reconstructed in 38 children-15 children with an absent thumb distal to the metacarpal base but with four relatively normal fingers; 12 children with an absent thumb and only one or two digits remaining on the ulnar side of the hand; and 11 children with complete absence of all five digits. Twenty-nine second toes and 12 great toes were transferred to reconstruct congenital absent thumbs. Fifty-nine fingers in 52 children were reconstructed mostly with single second toe transfers-41 children with a thumb but absence of all four fingers and 11 children with absence of all five digits. CONCLUSIONS The morphological or radiographic anatomy of a child's hand with congenital absent digits is a more logical indication for microsurgical reconstruction than any embryological classification. The three most common indications for toe transfers for reconstruction of congenital absent thumbs are (1) absent thumb distal to the carpometacarpal joint with four relatively normal fingers, (2) absent thumb with only one or two fingers remaining on the ulnar border of the hand, and (3) complete absence of the thumb and all four fingers. The two indications for toe transfers for reconstruction of congenital absent fingers are (1) absence of all four fingers but with a normal thumb remaining and (2) complete absence of all five digits.
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Affiliation(s)
- Neil F. Jones
- Center for Hand and Upper Extremity Surgery, Department of Orthopedic Surgery and Division of Plastic and Reconstructive Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868 USA ,University of California, Los Angeles, Los Angeles, CA 90095 USA ,Shriners Hospital Los Angeles, 3160 Geneva St., Los Angeles, CA 90020 USA
| | - Jesse Kaplan
- Center for Hand and Upper Extremity Surgery, Department of Orthopedic Surgery and Division of Plastic and Reconstructive Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA 92868 USA ,Shriners Hospital Los Angeles, 3160 Geneva St., Los Angeles, CA 90020 USA
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Valenti P, Leclère FM. [Distal reconstruction of the finger with a partial toe transfer in the child]. ACTA ACUST UNITED AC 2013; 32 Suppl 1:S57-62. [PMID: 23856548 DOI: 10.1016/j.main.2013.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 03/01/2013] [Accepted: 03/02/2013] [Indexed: 11/27/2022]
Abstract
Distal reconstruction of the finger or the thumb with a "custom-made" arterialized toe transfer in the child is a sophisticated operation. This operation can restore an excellent hand function and good cosmetic result with reduced morbidity at the donor site. Characteristics of these microsurgical toe transfers in the child are the potential of nerve regeneration and the conservation of a growth potential of the phalanx. We report 10 cases of reconstruction of a part of the distal finger in children (nail, pulp, bone) with a high degree of parents' satisfaction.
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Affiliation(s)
- P Valenti
- Clinique Jouvenet, institut de la main, 6, square Jouvenet, 75016 Paris, France.
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Long-term results of finger reconstruction with microvascular toe transfers after trauma. J Plast Reconstr Aesthet Surg 2011; 64:1291-9. [DOI: 10.1016/j.bjps.2011.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 04/15/2011] [Accepted: 04/28/2011] [Indexed: 11/24/2022]
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Kvernmo HD, Tsai TM. Posttraumatic reconstruction of the hand--a retrospective review of 87 toe-to-hand transfers compared with an earlier report. J Hand Surg Am 2011; 36:1176-81. [PMID: 21712137 DOI: 10.1016/j.jhsa.2011.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 04/13/2011] [Accepted: 04/13/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to retrospectively review the results of 87 toe-to-hand transfers performed in 73 procedures, compare them to the report published by the senior author in 1983, and confirm the hypothesis that results of toe-to-hand transfers at our center have improved over time. METHODS The results of 87 toe-to-hand transfers performed between 1981 and 2001 were reviewed and compared with the results of 54 toe-to-hand transfers performed between 1974 and 1980. The measured parameters were type of reconstruction performed, anticoagulation therapy, vascular patency, frequency of secondary surgery, and strength of thumb reconstructions. RESULTS In the recent time period, 11% of the procedures had complications with revascularization of the transferred digit, and long-term survival was seen in 98% of the toe-to-hand transfers. This is a significant improvement over earlier results, in which 33% of the cases had some microvascular compromise and the survival of grafts was lower (91%). Pinch strength for thumb reconstructions improved, and the number of secondary surgeries performed dropped, but neither of these parameters reached a significant level. Toes used for reconstruction changed, with an 18% decrease in use of big toe for thumb reconstruction and a similar increase in use of the second toe. For non-thumb digital reconstructions there was a 60% decrease in use of second and third toe combined, whereas use of the second toe alone increased similarly. CONCLUSIONS This study showed reduction of the incidence of vascular compromise compared to the previous report. Improved strength of thumb reconstructions and reduced need for secondary surgery was also displayed. These findings are likely attributed to refinements in reconstructive procedures and operative techniques. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Hebe D Kvernmo
- Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville School of Medicine, Department of Surgery, Division of Hand Surgery, Louisville, KY, USA
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Abstract
Heterodigital pedicle flaps have 2 possible patters of vascularization: anterograde flow (Littler) or reverse flow (Adani). The Adani's flap uses the Y-V pedicle lengthening principle. The flap is raised from the adjacent uninjured finger based on the digital artery. The common digital artery is ligated and a long pedicle is formed from the 2 converging digital arteries to supply a reverse flow flap. Four patients with severe fingertips injuries were submitted to surgical treatment with the Adani's flap. All flaps integrated and provided skin coverage. The Adani's flap has a long vascular pedicle that allows a wide arch of transposition. An easier vascular dissection in a site distant from the trauma which evolves a higher diameter digital artery and proximal interphalangeal arterial system promotes a high survival rate and good functional results. Adani's flap is a reliable technique for severe fingertip injuries.
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Yildirim S, Calikapan GT, Akoz T. Reconstructive microsurgery in pediatric population—A series of 25 patients. Microsurgery 2008; 28:99-107. [DOI: 10.1002/micr.20458] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Van Landuyt K, Hamdi M, Blondeel P, Tonnard P, Verpaele A, Monstrey S. Free Perforator Flaps in Children. Plast Reconstr Surg 2005; 116:159-69. [PMID: 15988263 DOI: 10.1097/01.prs.0000169697.06498.df] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Raising perforator flaps is said to be a tedious procedure. The benefits, however, are great. In adults, perforator flaps have proved their usefulness and reliability in various clinical situations. In children, donor sites for free flaps are particularly scarce because of the need for a long and reliable vascular pedicle of sufficient size. There is also the need to minimize donor-site morbidity from aesthetic, functional, and psychological perspectives. METHODS The authors present a series of 23 consecutive free perforator flaps performed by the first author in 20 children; ages at the time of operation ranged from premature (born at 28 weeks) to 16 years (mean age, 7 years 5 months). Three children presented with upper limb defects; the remaining 17 children sustained major soft-tissue defects of the lower limb. All the lesions necessitated extensive coverage with a free flap. Flaps used in this series included nine deep inferior epigastric artery perforator flaps, seven thoracodorsal artery perforator flaps, and seven compound ("chimera") thoracodorsal artery perforator flaps. RESULTS All flaps but one were successful. With a follow-up of up to 7 years, the results in this series compare favorably with those of perforator flaps in adults or pediatric free flaps in the literature. CONCLUSIONS In children, as in adults, perforator flaps are a valuable alternative to the traditional muscle or myocutaneous free flap. Because of the added advantage of reducing donor-site morbidity, perforator flaps have become the authors' preferred option in reconstructive cases in children.
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Affiliation(s)
- Koenraad Van Landuyt
- Department of Plastic and Reconstructive Surgery, University Hospital Gent, Gent, Belgium.
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Wei FC, Mardini S. Reevaluation of the Technique of Toe-to-Hand Transfer for Traumatic Digital Amputations in Children and Adolescents. Plast Reconstr Surg 2003; 112:1870-4. [PMID: 14663233 DOI: 10.1097/01.prs.0000091362.12415.6b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Fu-Chan Wei
- Department of Plastic Surgery, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taipei, Taiwan.
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Hofer SOP, Cronin KJ, Morrison WA. A long-term study of ring finger transfer in the reconstruction of transmetacarpal amputations. J Hand Surg Am 2002; 27:1087-94. [PMID: 12457362 DOI: 10.1053/jhsu.2002.35883] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Restoration of adequate function in patients with metacarpal hands is a major challenge. In 1984, we presented a technique in which the contralateral uninjured ring finger was transferred by microvascular techniques to restore the dual hand functions of pinch and palmar grips. This was performed in combination with thumb reconstruction when necessary. The original 5 patients described in 1984, as well as 2 later cases, were reviewed for a long-term follow-up study (average, 19 y; range, 8-25 y). The average age of the patients at follow-up evaluation was 44 years (range, 13-73 y). Range of motion, grip span, sensibility, and grip strengths were measured. The Disabilities of the Arm, Shoulder, and Hand outcome measure was used to evaluate disability. The data show persistent good function with improving sensibility over the years. The ring finger transfer in reconstruction of transmetacarpal amputation has proven to be a good technique with an overall satisfactory outcome, especially in its ability to restore some capacity for palmar grip, a function that has hitherto been unattainable by other means.
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Affiliation(s)
- Stefan O P Hofer
- Department of Plastic and Reconstructive Surgery, St.Vincent's Hospital, University of Melbourne, and Bernard O'Brien Institute of Microsurgery, Melbourne, Australia
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Affiliation(s)
- Kazuteru Doi
- Department of Orthopaedics, Ogori Daiichi General Hospital, 862-3 Shimogo, Ogori-cho, Yoshiki-gun, Yamaguchi prefecture 754 0002, Japan.
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Tomaino MM. Restoration of functional prehension after radial hemihand amputation in a three-year-old child: rationale for and long-term result after great toe transfer. J Hand Surg Am 2001; 26:617-22. [PMID: 11466634 DOI: 10.1053/jhsu.2001.26022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Partial hand amputations are rare injuries among children, causing significant functional impairment. Reports on thumb reconstruction in children and adults are used to develop a reconstruction plan for restoring prehension. While either first or second toe transplantation may be indicated to restore prehension in adults with thumb loss, near universal reluctance to use the great toe in children centers around concern regarding the subsequent function and appearance of the foot. This report details the reconstruction of functional prehension after radial hemihand amputation in a 3-year-old child. Great toe transplantation was used and resulted in neither objective nor subjective donor site morbidity. The rationale for use of the great toe in this child and long-term functional outcome are described.
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Affiliation(s)
- M M Tomaino
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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