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Hellevuo C, Jokihaara J, Kaistila T, Leppänen OV, Vilkki SK. Long-term donor site outcome after second toe transfer for congenital hand differences. J Hand Surg Eur Vol 2024; 49:899-904. [PMID: 37974337 DOI: 10.1177/17531934231211569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
This study evaluates the long-term donor site outcomes after second toe transfers for congenital hand differences performed during childhood. In total, 25 toe transfers in 18 patients were followed up for a mean period of 17.4 years. We examined the patients clinically, radiologically and with a gait analysis system. Patient-reported outcome measures were collected. The patients were asymptomatic and there were no problematic clinical or radiological findings. Patients expressed high levels of satisfaction. The results were consistent, regardless of the resection level in the toe transfer or whether the operation was unilateral or bilateral. No postoperative complications or late reoperations on the foot were observed.Level of evidence IV.
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Affiliation(s)
- Camilla Hellevuo
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tiina Kaistila
- Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland
| | - Olli V Leppänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Simo K Vilkki
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
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Tonni G, Grisolia G, Bonasoni MP, Rizzo G, Werner H, Sepulveda W, Ruano R, Araujo Júnior E. Fetal Hands: A Comprehensive Review of Prenatal Assessment and Diagnosis Over the Past 40 Years. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:657-676. [PMID: 36526543 DOI: 10.1016/j.ultrasmedbio.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy.
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Maria Paola Bonasoni
- Human Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI-DASA), Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Simultaneous Stiles-Bunnell Tendon Transfer Enhances Intrinsic Function of Second-Toe Transplantations. Plast Reconstr Surg 2017; 140:1229-1234. [DOI: 10.1097/prs.0000000000003861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Ju JH, Hou RX. One-stage cosmetic finger reconstruction using a second toe island flap containing terminal branches of the toe artery. Orthop Traumatol Surg Res 2015; 101:345-51. [PMID: 25819289 DOI: 10.1016/j.otsr.2014.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 08/22/2014] [Accepted: 12/02/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A finger reconstructed by toe transfer may have morphological defects. We report the results of second toe transfer for 1-stage finger reconstruction with an island flap based on terminal branches of the toe artery. HYPOTHESIS The technique can improve the morphological outcomes of reconstructed fingers. MATERIALS AND METHOD Between January 2008 and June 2011, toe-to-finger transfer was performed for 36 fingers in 31 patients. An island flap containing terminal branches of the toe artery was embedded in the neck of the second toe to eliminate the morphological defect caused by stenosis in that area. RESULTS All reconstructed fingers and all flaps survived. No donor site complications occurred. The mean follow-up was 8 months (range, 5 to 25 months). The morphology of the reconstructed finger was close to that of a normal finger, and a natural transition could be observed in the finger pulp, the finger neck, and the junction between the toe and the finger. Sensory recovery of the finger pulp ranged from S1 to S3+. The mean pinch strength of the reconstructed fingers was 48% to 60% of that of the contralateral side. The mean DASH scores were 52.9, 48.9, and 46.0 for patients that had the index, third, and fourth fingers reconstructed, respectively, and the lowest mean aesthetic score was 70. DISCUSSION The method provides good aesthetic and functional outcomes, and overcomes aesthetic difficulties associated with other methods of toe transfer for finger reconstruction.
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Affiliation(s)
- J-H Ju
- Department of Hand Surgery, Ruihua affiliated Hospital of Soochow University, 5, Tayun Road, Yuexi Town, Wuzhong District, 215104 Suzhou, PR China
| | - R-X Hou
- Department of Hand Surgery, Ruihua affiliated Hospital of Soochow University, 5, Tayun Road, Yuexi Town, Wuzhong District, 215104 Suzhou, PR China.
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Camporro D, González I, Martín C. Isolated second toe transfer after total amputation of the left fifth finger in a professional guitar player. J Hand Surg Eur Vol 2014; 39:1003-4. [PMID: 24127464 DOI: 10.1177/1753193413508689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Camporro
- Hospital Universitario Central de Asturias, Department of Plastic and Reconstructive Surgery, Department of Physical Medicine and Rehabilitation, Oviedo, Spain
| | - I González
- Hospital Universitario Central de Asturias, Department of Plastic and Reconstructive Surgery, Department of Physical Medicine and Rehabilitation, Oviedo, Spain
| | - C Martín
- Hospital Universitario Central de Asturias, Department of Plastic and Reconstructive Surgery, Department of Physical Medicine and Rehabilitation, Oviedo, Spain
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Risk factors for reexploration in toe-to-hand transfer: a multivariate analysis of 363 cases. Plast Reconstr Surg 2014; 135:501-506. [PMID: 25357159 DOI: 10.1097/prs.0000000000000884] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reexploration after toe-to-hand transfer increases the risk of failure. In this study, the authors aimed to identify risk factors for reexploration after toe-to-hand transfer. METHODS The medical records of 363 patients who underwent single toe-to-hand transfer between 2000 and 2010 were reviewed retrospectively. Patient demographics, clinical data, and operative data were collected, and multivariate analysis was performed. RESULTS Of these 363 patients, 299 toes (82.4 percent) had primary success in transplantation. Sixty-four toes required reexploration, of which seven toes failed. The overall success rate was 98.1 percent. Of the 64 toes that required reexploration, arterial spasm was found in 39 (60.9 percent), arterial thrombosis was found in 27 (42.2 percent), and venous thrombosis was found in 16 (25.0 percent). Multivariate logistic regression analysis revealed that postoperative wound infection, metacarpal hand injuries, and preceding flap coverage were independently associated with reexploration. CONCLUSIONS Reducing reexploration in toe-to-hand transfer may be facilitated by managing or avoiding these risk factors. Particular attention must be paid to avoid postoperative wound infection, which was the single greatest factor contributing to reexploration (adjusted OR, 12.6). CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Maruccia M, Kiranantawat K, Yeo MSW, Nicoli F, Ciudad P, Chen HC. Donor site of toe transfer: is combined second and third toe transfer the better choice? A 31 years of long-term follow-up. Microsurgery 2014; 34:500-1. [PMID: 24788916 DOI: 10.1002/micr.22268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 04/14/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Michele Maruccia
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
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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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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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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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Wallace CG, Lin YT, Wei FC. Toe-to-Hand Transfers. Plast Reconstr Surg 2010. [DOI: 10.1007/978-1-84882-513-0_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fumiaki S, Wei FC, Sassu P, Lin CH, Lin YT. Multiple toe transplantations to reconstruct three amputated neighbouring distal fingers by heat press injury – a case report. J Plast Reconstr Aesthet Surg 2009; 62:e309-13. [DOI: 10.1016/j.bjps.2007.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 12/11/2007] [Accepted: 12/15/2007] [Indexed: 10/21/2022]
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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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Abstract
This article outlines current methods of toe transplantation as applied to posttraumatic finger reconstruction (excluding the thumb). Key points that are important during the initial assessment and surgical treatment of such injuries are addressed. Reconstructive options for distal and proximal finger injuries, single and multiple finger injuries, and metacarpal hand injuries are presented, and the timing of toe transplantation procedures is discussed. Finally, additional concepts and techniques that, with experience, have proved useful for optimizing functional and esthetic results are highlighted, along with schemes for motor and sensory rehabilitation.
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Affiliation(s)
- Christopher G Wallace
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University Medical College, 199 Tun Hwa North Road, Taipei, Taiwan
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