Toe Transfer in Congenital Hand Malformations

ABSTRACT

Fifty-eight patients with congenital hand abnormalities underwent 65 toe-to-hand transfers. Symbrachydactyly (51 cases) was the most frequent indication. Forty-seven second toe-to-hand transfers were performed in 44 patients. The mean follow-up time was 5.2 years. Two failures occurred in cases in which only one artery was anastomosed; no failures were noted when more than one artery fed the transfer. Two patients with a single second-toe transfer presented with lateral instability of the transferred metatarsophalangeal joint. The mean active range of motion was 38°, with a mean extension lag of 25°. The mean two-point discrimination was 5 mm. Forty-one patients used the transferred toe well, when performing activities of daily living and playing games. Toe-to-hand transfer, prior to the establishment of the grip pattern, facilitates integration of the transfer.

REFERENCES

• 1 Buncke H J, McLean D H, George P J. Thumb replacement: great toe transplantation by microvascular anastomosis.  Br J Plast Surg . 1973;  26 194-201
• 2 Cobett J R. Free digital transfer: report of a case of transfer of a great toe to replace an amputated thumb.  J Bone Joint Surg . 1969;  51 677-679
• 3 Boyer M I, Mih A D. Microvascular surgery in the reconstruction of congenital hand anomalies.  Hand Clin . 1998;  14 135-142
• 4 Eaton C J, Lister G D. Toe transfer for congenital hand defects.  Microsurgery . 1991;  12 186-195
• 5 Foucher G. Toe to hand transfer in congenital malformations.  J Orthopaed Surg Tech . 1993;  8 207-215
• 6 Foucher G. Le transfer d'orteil dans les malformations congénitales de la main.  Bull Acad Natl Med . 1997;  181 1734-1744
• 7 Gilbert A. Toe transfers for congenital hand defects.  J Hand Surg . 1982;  7B 118-124
• 8 Vilkki S K. A technique for toe-to-stump transplantation after wrist amputation: a modern alternative to the Krukenberg operation.  Handchir Microchir Plast Chir . 1985;  75 584-587
• 9 Foucher G, Norris R W. The dorsal approach in harvesting the second toe.  J Reconstr Microsurg . 1988;  4 185-187
• 10 Foucher G. Second toe-to-finger transfer in hand mutilations.  Clin Orthop . 1995;  314 8-12
• 11 Bissonnette B. Thermoregulation and paediatric anaesthesia.  Curr Opin Anaesthesiol . 1993;  6 537-542
• 12 Lister G D, Kalisman M, Tsai T M. Reconstruction of the hand with free microneurovascular toe to hand transfer: experience with 54 toe transfers.  Plast Reconstr Surg . 1983;  71 372-384
• 13 Gilbert A. Composite tissue transfers from the foot-anatomic basis and surgical technique. In: Daniller AI Strauch B (eds): Symposium on Microsurgery. St. Louis: CV Mosby 1976
• 14 Foucher G, Moss A LH. Microvascular second toe to finger transfer: a statistical analysis of 55 transfers.  Br J Plast Surg . 1991;  44 87-90
• 15 Foucher G. Vascularized joint transfers. In: Green D (ed): Operative Hand Surgery, 2nd ed. NY: Churchill Livingstone, 1988, pp 1271-1293
• 16 Yoshimura M. Toe to hand transfer.  Plast Reconstr Surg . 1984;  73 851-852
• 17 Kay S P, Wiberg M. Toe to hand transfer in children. Part I: Technical aspects.  J Hand Surg . 1996;  21B 723-734
• 18 Blauth W, Gekeler J. Zur Morphologie und Klassifikation der Symbrachydaktylie.  Handchirurgie . 1971;  3 123-128
• 19 Blauth W, Gekeler J. Symbrachydaktylien.  Handchirurgie . 1973;  5 121-171
• 20 Buck-Gramcko D. Symbrachydactyly: a clinical entity.  Tech Hand Upper Extrem Surg . 1999;  3 242-258
• 21 Ogino T, Minami A, Kato H. Clinical features and roentgenograms of symbrachydactyly.  J Hand Surg . 1989;  14 303-306
• 22 Manske P R. Symbrachydactyly instead of atypical cleft hand.  Plast Reconstr Surg . 1993;  91 196
• 23 Miura T, Nakamura R, Horii E. The position of symbrachydactyly in the classification of congenital hand anomalies.  J Hand Surg . 1994;  19B 350-354
• 24 Foucher G. The ``stub'' operation-modification of the Furnas and Vilkii technique in traumatic and congenital carpal hand reconstruction.  Ann Acad Med Singapore . 1995;  24 73-76
• 25 Furnas D W, Achauer B M. Microsurgical transfer of the great toe to the radius to provide prehension after partial avulsion of the hand.  J Hand Surg . 1983;  8A 453-460
• 26 Vilkki S K. A technique for toe-to-stump transplantation after wrist amputation: a modern alternative to the Krukenberg operation.  Handchir Mikrochir Plast Chir . 1985;  75 584-587
• 27 Foucher G, Sammut D, Citron N. Free vascularized toe joint transfer in hand reconstruction: a series of 25 patients.  J Reconstr Microsurg . 1990;  6 201-207
• 28 Buck-Gramcko D. Symbrachydactyly: a clinical entity.  Tech Hand Upper Extrem Surg . 1999;  3 242-258
• 29 Carroll R E, Green D P. Reconstruction of hypoplastic digits using toe phalanges.  J Bone Joint Surg . 1975;  57A 727-730
• 30 Goldberg N H, Watson H K. Composite toe (phalanx and epiphysis) transfer in the reconstruction of the aphalangic hand.  J Hand Surg . 1982;  7 454-459
• 31 Radocha R F, Netscher D, Kleinert H E. Toe phalangeal grafts in congenital hand anomalies.  J Hand Surg . 1993;  18A 833-841
• 32 Manske P R, McCaroll H R. Type IIIa hypoplastic thumb.  J Hand Surg . 1995;  20A 246-253
• 33 Bradbury E T, Kay S P, Hewison J. The psychological impact of microvascular free toe transfer for children and their parents.  J Hand Surg . 1994;  19B 689-695
• 34 Pillet J. The aesthetic hand prosthesis.  Orthop Clin North Am . 1981;  96 969-973
• 35 Spokevicius S, Radzevicius D. Late toe-to-hand transfer for the reconstruction of congenital defects of the long fingers.  Scand J Plast Reconstr Surg Hand Surg . 1997;  31 345-350