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J Reconstr Microsurg 2004; 20(3): 215-225
DOI: 10.1055/s-2004-823109
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Microsurgical Second Toe-Metatarsal Bone Transfer for Reconstructing Congenital Radial Deficiency with Hypoplastic Thumb

Yuan-Kun Tu1 , Wen-Lin Yeh1 , Kanit Sananpanich2 , Steve Wen-Neng Ueng1 , Ying-Chao Chou1 , Ching-Hou Ma1 , Zhon-Liau Lee1
  • 1Department of Orthopedics, Chang Gung Memorial Hospital, Linkou, Taiwan
  • 2Department of Orthopedics, Chiangmai University, Chiangmai, Thailand
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Publikationsverlauf

Accepted: 2 December 2003

Publikationsdatum:
16. April 2004 (online)

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This study describes a consecutive series of 11 children who received a microsurgical second toe-metatarsal bone transfer for reconstructing a hypoplastic thumb associated with radial club hand, between 1996 and 2000. The parents refused pollicization in all cases for aesthetic and cultural reasons. Surgery was intended to improve hand function and cosmetic appearance. The average patient age was 3 years, and the average follow-up period was 4 years. Average surgery time for the second toe-metatarsal bone transplantation was 8 hr. The primary success rate was 90.9 percent, with one patient requiring repeat surgery owing to venous occlusion. The surgical outcomes reveal a normal growth of the transferred toe, an acceptable range of motion, and satisfactory recovery of sensation. All children achieved both small and large grasp functions. The parents were satisfied with the reconstruction procedures. Based on the preliminary results, second toe-metatarsal bone transfer appears an acceptable alternative for reconstructing radial deficiency with hypoplastic thumb.

KEYWORDS

Radial club hand - hypoplastic thumb - second toe-metatarsal bone flap - microsurgical toe transfer

REFERENCES

  • 1 Lister G. Pollex abductus in hypoplasia and duplication of the thumb.  J Hand Surg. 1991;  16A 626-633
    PubMedGoogle Scholar
  • 2 Scheker L R, Cendale L C. Correcting congenital thumb anomalies in children: opponensplasty and pollicization. In: Gupta A, Kay SPJ, Scheker LR The Growing Hand. London; Mosby 2000: 171-182
    Google Scholar
  • 3 Blauth W. Der hypoplastische daumen.  Arch Orthop Unfall-Chir. 1967;  62 225-246
    CrossrefPubMedGoogle Scholar
  • 4 Manske P R, McCarroll Jr H R. Reconstruction of the congenitally deficient thumb.  Hand Clin. 1992;  8 177-196
    CrossrefPubMedGoogle Scholar
  • 5 Swanson A B. A classification for congenital limb malformations.  J Hand Surg. 1976;  1A 8-22
    PubMedGoogle Scholar
  • 6 Bayne L G, Klug M S. Long-term review of the surgical treatment of radial deficiencies.  J Hand Surg. 1987;  12A 169-179
    PubMedGoogle Scholar
  • 7 Flatt A E. Radial club hand. In: Flatt AE The Care of Congenital Anomalies, 2nd ed. St Louis; Quality Medical Publishing 1994: 366-410
    Google Scholar
  • 8 Kay S P, Wiberg M, Bellew M, Webb F. Toe-to-hand transfer in children. Part 2: Functional and psychological aspects.  J Hand Surg. 1996;  21B 735-745
    PubMedGoogle Scholar
  • 9 Shibata M. Metatarsophalangeal joint transfer for type IIIB hypoplastic thumb. In: Gupta A, Kay SPJ, Scheker LR The Growing Hand. London; Mosby 2000: 183-188
    Google Scholar
  • 10 Littler J W. On making a thumb. One hundred years of surgical efforts.  J Hand Surg. 1976;  1A 35-51
    PubMedGoogle Scholar
  • 11 Littler J W. The neurovascular pedicle method of digital transposition for reconstruction of the thumb.  Plast Reconstr Surg. 1953;  12 303-319
    CrossrefPubMedGoogle Scholar
  • 12 Littler J W. Digital transposition.  Curr Pract Orthop Surg.. 1966;  3 157-172
    PubMedGoogle Scholar
  • 13 Clark D I, Chell J, Davis T R. Pollicization of the index finger. A 27 year follow-up study.  J Bone Joint Surg. 1998;  80B 631-635
    PubMedGoogle Scholar
  • 14 Kay S P, Wiberg M. Toe to hand transfer in children. Part 1. Technical aspects.  J Hand Surg. 1996;  21B 723-734
    PubMedGoogle Scholar
  • 15 Buncke G M, Buncke H J, Oliva A, Lineaweaver W C, Siko P P. Hand reconstruction with partial toe and multiple transplants.  Clin Plast Surg. 1992;  19 859-870
    PubMedGoogle Scholar
  • 16 Wei F C, Colony L H, Chen H C, Chuang C C, Noordhoff M S. Combined second and third toe transfer.  Plast Reconstr Surg. 1989;  84 651-661
    PubMedGoogle Scholar
  • 17 Vilkki S. Advances in microsurgical reconstruction of the congenitally adactylous hand.  Clin Orthop. 1995;  314 44-58
    PubMedGoogle Scholar
  • 18 Bradbury E T, Kay S P, Tighe C, Hewison J. Decision-making by parents and children in pediatric hand surgery.  Br J Plast Surg. 1994;  47 324-330
    PubMedGoogle Scholar
  • 19 Wilson R C, Yates A PB. Pediatric microvascular surgery anesthetic experience of 27 toe-to-hand transfers.  Pediatr Anesth. 1993;  3 209-215
    PubMedGoogle Scholar
  • 20 Royle N D. An operation for paralysis of the intrinsic muscles of the thumb.  JAMA. 1938;  111 612
    CrossrefPubMedGoogle Scholar
  • 21 Huber E. Hilfsoperation bei Medianuslahmung.  Dtsch Z Chir. 1921;  162 271-275
    CrossrefPubMedGoogle Scholar
  • 22 Cobbett J R. Free digital transfer. Report of a case transfer of a great toe to replace an amputated thumb.  J Bone Joint Surg. 1969;  51B 677-679
    PubMedGoogle Scholar
  • 23 Bunke H J, Bunke C M, Schulz W P. Immediate Nicoladoni procedure in Rhesus monkey hallux-to-hand transplantation utilizing microminiature anastomosis.  Br J Plast Surg. 1966;  19 332-337
    PubMedGoogle Scholar
  • 24 Wei F C, El-Gammal T A, Lin C H, Chuang C C, Chen H C, Chen S H. Metacarpal hand: classification and guidelines for microsurgical reconstruction with toe transfers.  Plast Reconstr Surg. 1999;  99 122-128
    PubMedGoogle Scholar
  • 25 Wei F C, El-Gammal T A, Chen H C, Chuang C C, Chiang Y C, Chen S H. Toe-to-hand transfer for traumatic digital amputations in children and adolescents.  Plast Reconstr Surg. 1997;  100 605-609
    PubMedGoogle Scholar
  • 26 Wei F C, Strauch R J, Chen H C, Chuang C C. Reconstruction of four damaged or destroyed ipsilateral fingers with free toe-to-hand transplantations.  Plast Reconstr Surg. 1994;  93 608-614
    PubMedGoogle Scholar
  • 27 Gilbert A. Toe transfers for congenital hand defects.  J Hand Surg. 1982;  7A 118-126
    PubMedGoogle Scholar
  • 28 Boyer M I, Mih A D. Microvascular surgery in the reconstruction of congenital hand anomalies.  Hand Clin. 1998;  14 135-142
    PubMedGoogle Scholar
  • 29 Van Holder C, Giele H, Gilbert A. Double second toe transfer in congenital hand anomalies.  J Hand Surg. 1999;  24B 471-475
    PubMedGoogle Scholar
  • 30 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
    PubMedGoogle Scholar
  • 31 O'Brien B M, Black M J, Morrison W A, MacLeod A M. Microvascular great toe transfer for congenital absence of the thumb.  Hand. 1978;  10 113-124
    PubMedGoogle Scholar
  • 32 Nyarady J, Szekeres P, Vilmos Z. Toe-to-thumb transfer in congenital grade III thumb hypoplasia.  J Hand Surg. 1983;  8A 898-901
    PubMedGoogle Scholar
  • 33 Berger A. Reconstruction of the thenar muscles by microsurgery.  Scand J Plast Reconstr Surg. 1986;  20 153-155
    PubMedGoogle Scholar
  • 34 Shibata M, Yoshizu T, Seki T, Goto M, Saito H, Tajima T. Reconstruction of a congenital hypoplastic thumb with use of a free vascularized metatarsophalangeal joint.  J Bone Joint Surg. 1998;  80A 1469-1476
    PubMedGoogle Scholar
  • 35 Eaton C J, Lister G D. Toe transfer for congenital hand defects.  Microsurgery. 1991;  12 186-195
    PubMedGoogle Scholar
  • 36 Bowen C VA, Ethridge C P, O'Brien B M, Frykman G K, Gumley G J. Experimental microvascular free growth plate transfers. Part 1-Investigation of vascularity.  J Bone Joint Surg. 1988;  70B 305-310
    PubMedGoogle Scholar
  • 37 Zaleske D J, Ehrlich M G, Piliero C et al.. Growth plate behavior in whole joint replantation in rabbit.  J Bone Joint Surg. 1982;  64A 249-257
    PubMedGoogle Scholar
  • 38 Rayner C R. Microsurgery in the treatment of congenital hand deformities. In: Meyer VE, Black JM Microsurgical Procedures. London; Churchill Livingstone 1991: 240-253
    Google Scholar
  • 39 Lister G D. Microsurgical transfer of the second toe for congenital deficiency of the thumb.  Plast Reconstr Surg. 1988;  82 658-665
    CrossrefPubMedGoogle Scholar

Zhon-Liau LeeM.D. 

Department of Orthopedics, Chang Gung Memorial Hospital

Linkou, No. 5 Fu-Hsin Road

Kwei-Shan, Tao-Yuan, Taiwan