Functional Evaluation of a Great Toe Transfer and the Osteoplastic Technique for Thumb Reconstruction in the Same Individual

2003 ◽  
Vol 28 (5) ◽  
pp. 405-408 ◽  
Author(s):  
S. R. SABAPATHY ◽  
H. VENKATRAMANI ◽  
R. R. BHARATHI
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Functional Evaluation ◽  
Great Toe ◽  
Thumb Reconstruction ◽  
Microsurgical Reconstruction ◽  
Functional Activities ◽  
Reconstructive Option ◽  
Toe Transfer

Since the popularization of microvascular toe transfer, there has been a tendency to relegate osteoplastic reconstruction techniques for the thumb to history. A case is presented which shows that a successful and well-planned osteoplastic thumb reconstruction can match microsurgical reconstruction in all functional activities. Cosmetically, the toe transfer is the better reconstructive option but it may cause significant donor site morbidity.

Gait Analysis of the Donor Foot in Microsurgical Reconstruction of the Thumb

1995 ◽  
Vol 16 (4) ◽  
pp. 201-206 ◽  
Author(s):  
Francesco Barca ◽  
Alessandro Santi ◽  
Pier Luigi Tartoni ◽  
Antonio Landi
Keyword(s):  
Donor Site ◽  
Hallux Rigidus ◽  
Metatarsal Bone ◽  
Wilcoxon Test ◽  
Great Toe ◽  
Microsurgical Reconstruction ◽  
The Third ◽  
Metatarsal Bones ◽  
Toe Transfer ◽  
Second Toe

Clinical and step evaluations by a piezoelectric system board were performed in 54 patients who underwent microsurgical reconstruction of the thumb by great or second toe transfer. Forty-four patients were male and 10 were female. In 13 cases, the thumb was reconstructed by the Morrison wrap-around technique. In 27 cases, an extended variant of the Morrison technique was used in which the whole distal phalanx was harvested with skin and nail apparatus. Four patients were treated by great toe transfer and 10 were treated by second toe transfer. Follow-up ranged from 2 to 144 months. The group of patients treated by the wrap-around technique presented hallux rigidus in 38.5% of cases. The group of patients treated by the extended variant of the Morrison technique presented a lesser tendency to hallux rigidus but a clear reduction of the pushing phase of hallux. The group of patients treated by second toe transfer presented a third and fourth metatarsal bone overload that was confirmed by a statistical Wilcoxon test: overload was linked to a plantar hyperkeratosis at the third metatarsal (20%), fourth metatarsal (10%), or fifth metatarsal bone (20%). A claw deformity of the third and fourth toes was observed in 20% of these patients. The four patients who underwent microsurgical reconstruction of the thumb by great toe transfer exhibited an overload of central and lateral metatarsal bones. Second toe transfer is not associated with the functional or cosmetic changes seen in great toe transfer and is therefore preferred. The cosmetic and functional results from extended great toe transfer make this a much less desirable transfer than the wrap-around or modified wrap-around technique. The transfer with the least donor site problem is second toe to thumb.

Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

2005 ◽  
Vol 26 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Frederick J. Duffy ◽  
James W. Brodsky ◽  
Christian T. Royer
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Microsurgical Reconstruction ◽  
Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

Functional Donor Site Morbidity Following Vascularized Toe Transfer Procedures

2014 ◽  
Vol 134 ◽  
pp. 37
Author(s):  
Michael Sosin ◽  
Yu-Te Lin ◽  
John Steinberg ◽  
Noah Oliver ◽  
Ketan M. Patel
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Transfer Procedures ◽  
Toe Transfer

Outcomes of Dog Bite Avulsion Injury Reconstruction With Urinary Bladder Matrix

2020 ◽  
Vol 163 (6) ◽  
pp. 1166-1168
Author(s):  
Adrian A. Ong ◽  
Ryan Nagy ◽  
Michelle R. Fincham ◽  
Mark L. Nagy
Keyword(s):  
Urinary Bladder ◽  
Head And Neck ◽  
Pediatric Patients ◽  
Donor Site ◽  
Graft Loss ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Dog Bite ◽  
Urinary Bladder Matrix ◽  
Reconstructive Option

Dog bite avulsion injuries of the head and neck are difficult to manage in pediatric patients. This study assesses the outcomes of using porcine urinary bladder extracellular matrix (UBM) for reconstruction of these complete avulsion injuries. Five male pediatric patients underwent reconstruction using UBM. Two (40%) patients underwent reconstruction of the nose; the other 3 patients underwent reconstruction of the forehead, forehead/glabella, and auricle. The average size of the avulsion defect was 7.0 ± 2.4 cm2. No patient developed wound dehiscence, graft loss, or wound infection. Four (80%) patients received pulsed dye laser treatment to improve wound cosmesis. Use of UBM is a safe and effective reconstructive option after dog bite avulsion injuries of the head and neck. Given the advantages of convenient availability and avoidance of donor site morbidity, UBM can be considered for reconstruction of posttraumatic avulsion injuries or Mohs defects.

Thumb Reconstruction—Great Toe Transfer

1989 ◽  
Vol 16 (3) ◽  
pp. 475-489 ◽  
Author(s):  
Fredrick A. Valauri ◽  
Harry J. Buncke
Keyword(s):  
Great Toe ◽  
Thumb Reconstruction ◽  
Toe Transfer

scholarly journals Bilateral Metacarpal Hands: Reconstruction With 6 Toe Transfers

Hand ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 465-471
Author(s):  
Neil F. Jones ◽  
David Graham ◽  
Katherine Au
Keyword(s):  
Functional Outcomes ◽  
Donor Site ◽  
Psychological Impact ◽  
Hand Surgery ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Hand Injuries ◽  
Great Toe ◽  
Hand Transplantation

Background: Bilateral metacarpal hand injuries are extremely rare, but probably represent the most difficult reconstructive challenge in hand surgery. Methods: We discuss the various options for metacarpal hand reconstruction, including the Krukenberg procedure, bionic prostheses, multiple toe-to-hand transfers, and possibly hand transplantation, and present the long-term functional outcomes, gait analysis, and psychological evaluation after a 4-stage reconstruction of bilateral metacarpal hands in a child using 6 toe-to-hand transfers—bilateral great toe transfers to reconstruct both thumbs and bilateral combined second-third monobloc transfers to reconstruct 2 fingers in each hand. Results: Reconstruction of bilateral metacarpal hands with 6 toe transfers yielded excellent functional results and patient satisfaction. Conclusions: Bilateral metacarpal hand injuries result in a devastating functional deficit and a major psychological impact. Multiple toe transfers (4, 5, or 6) provide an excellent reconstructive outcome with acceptable donor site morbidity.

scholarly journals Cosmetic and Functional Results of a Newly Reconstructed Thumb by Combining the Phalange of Second Toe and the Great Toenail Flap Transplantation

2020 ◽  
Author(s):  
Yefeng Yin ◽  
Xiaomei Tao ◽  
Yanzhao Li ◽  
Buhe Bao ◽  
Ying Ying ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Great Toe ◽  
Thumb Reconstruction ◽  
Aesthetic Result ◽  
Aesthetic Results ◽  
Distal Interphalangeal ◽  
The Common ◽  
Toe Transfer ◽  
Second Toe

Abstract BACKGROUND Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor aesthetics. Great toe transplantation achieves better aesthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and aesthetic satisfaction in thumb reconstruction.METHODS We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalange transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). RESULTS 1 patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and aesthetic results of both the donor and the recipient sites were satisfactory.CONCLUSIONS Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and 2nd toe phalange achieved a substantially better functional and aesthetic result in the thumb reconstruction.

Functional Donor Site Morbidity After Vascularized Toe Transfer Procedures

2016 ◽  
Vol 76 (6) ◽  
pp. 735-742 ◽  
Author(s):  
Michael Sosin ◽  
Cheng-Hung Lin ◽  
John Steinberg ◽  
Edward R. Hammond ◽  
Poysophon Poysophon ◽  
...  
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Transfer Procedures ◽  
Toe Transfer

scholarly journals Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yefeng Yin ◽  
Xiaomei Tao ◽  
Yanzhao Li ◽  
Buhe Bao ◽  
Ying Ying ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Great Toe ◽  
Distal Interphalangeal Joint ◽  
Thumb Reconstruction ◽  
Distal Interphalangeal ◽  
The Common ◽  
Toe Transfer ◽  
Second Toe ◽  
Different Levels

Abstract Background Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe, and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor esthetics. Great toe transplantation achieves better esthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and esthetic satisfaction in thumb reconstruction. Methods We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalanx transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). Results One patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and esthetic results of both the donor and the recipient sites were satisfactory. Results show that, for patients with traumatic thumb defects, the combined transfer of flap and second toe phalanx was the best option. Conclusions Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and second toe phalanx achieved a substantially better functional and esthetic result in the thumb reconstruction.

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