Extra-Anatomic Microvascular Second Toe Transfer for Creation of a Helper Hand – a Long-Term Follow-Up

In post-traumatic losses of the thumb and fingers, reconstruction can be performed with success using various combinations of toe transfers. In this study, we have presented second toe and combined toe transfers which have been followed up for more than 20 years. Second toe transfer was used in four patients for reconstruction of the thumb. Combined second and third toe transfer was performed in two patients with a metacarpal hand for finger reconstruction. Long-term follow-up results show that patients with toe-to-hand transfers have acceptable adaptation to the reconstructed hand and good hand function. Toe transfer should be individually planned and carefully executed to obtain optimal results and minimal disability in the donor foot.

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Non-vascularized toe phalanx transfer for correction of severe clinodactyly of the thumb in Rubinstein–Taybi syndrome

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420909784 ◽

2020 ◽

Vol 45 (7) ◽

pp. 715-721

Author(s):

Marie Le Mapihan ◽

Alina Badina ◽

Stéphanie Pannier ◽

Arielle Salon ◽

Chrisophe Glorion ◽

...

Keyword(s):

New Method ◽

New Technique ◽

Level Of Evidence ◽

Before And After ◽

Long Term Follow Up ◽

Osteotomy Technique ◽

Toe Transfer ◽

Delta Phalanx

In Rubinstein–Taybi syndrome, patients may have a particularly severe clinodactyly of the thumb. We evaluated a new method for correction of these severe clinodactylies using non-vascularized toe phalanx transfer as a replacement for the abnormal delta phalanx. Results of the new technique are presented, together with those of an osteotomy technique. We retrospectively recorded the angle of the clinodactyly before and after surgery and at long-term follow-up of 11 osteotomies and five transfers in nine patients from 1990 to 2017. The pre-operative angle of clinodactyli was similar between the two groups with a mean of 59°. After surgery, the correction was equivalent (7° and 11°). At the last follow-up (7 and 18 years), the relapse of clinodactyly was 17° for osteotomies and 1° for phalanx transfers. We noticed growth of the transferred phalanx, resulting in an excellent thumb length. We conclude that non-vascularized toe transfer can be an effective correction of severe clinodactyly and may be more stable than osteotomy in the long-term. Level of evidence: IV

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Microvascular Great Toe Transfer For Congenital Absence Of The Thumb

HAND ◽

10.1016/s0072-968x(78)80001-1 ◽

1978 ◽

Vol os-10 (2) ◽

pp. 113-124 ◽

Cited By ~ 45

Author(s):

B. Mcc. O'brien ◽

M. J. M. Black ◽

W. A. Morrison ◽

A. M. Macleod

Keyword(s):

Congenital Absence ◽

Great Toe ◽

Long Term Follow Up ◽

Toe Transfer

summary Two cases of microvascular great toe transfer for congenital absence of the thumb in children are reported. A rationale and operative details are discussed. A long term follow up is needed, but at this stage the results are most encouraging. There has been no interference with gait.

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Methods for Congenital Thumb Hypoplasia Reconstruction. A Review of the Outcomes for Ten Years of Surgical Treatment

Medicina ◽

10.3390/medicina55100610 ◽

2019 ◽

Vol 55 (10) ◽

pp. 610 ◽

Cited By ~ 3

Author(s):

Ozols ◽

Butnere ◽

Petersons

Keyword(s):

Functional Results ◽

Clinical Results ◽

New Techniques ◽

Extensor Indicis Proprius ◽

Thumb Hypoplasia ◽

Long Term Follow Up ◽

Grade Ii ◽

Second Toe

Background and objectives: Congenital thumb hypoplasia is a rare deformity of upper extremity. The incidence for thumb hypoplasia grade II–V is 1:10,000 newborns per year in Latvia. A technique for extensor indicis proprius (EIP) tendon transfer with subperiosteal fixation was developed and used for thumb hypoplasia grades II and IIIa. Pollicization or second-toe-to-hand transplantation with metatarsophalangeal (MTP) joint arthrodesis was used for the reconstruction of hypoplasia grade IIIb–V. The aim of this retrospective cohort study is to evaluate the outcomes for reconstruction techniques used in one surgical center during a ten-year period by one surgeon to evaluate functional and aesthetical outcomes for new techniques. Materials and Methods: In total, 21 patients were operated on during 2007–2017, and 18 of these patients were involved in this study. Long-term follow-up was completed to evaluate the functions and aesthetics of the hands. Results: disabilities of the arm, shoulder and hand (DASH) was 9.35 (8–10.7) for the second-toe-to-hand with MTP joint arthrodesis transplantation method for pollicization method 19.8 (6–26.7), and for the EIP tendon transposition, 14.54 (0.9–56.3). Conclusions: The postoperative functional parameters of congenital hand hypoplasia patients, regardless of the surgical method, are worse than the functional results of healthy patients. The use of the second-toe-to-hand with MTP joint arthrodesis transplantation method provides patients with congenital hand IIIb–V hypoplasia a stable and functional first finger formation. The functional results are comparable to the clinical results of the pollicization method while ensuring the creation of a five-digit hand.

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Partial second toe pulp free flaps in early childhood

Archives of Plastic Surgery ◽

10.5999/aps.2020.01137 ◽

2020 ◽

Vol 47 (6) ◽

pp. 590-596

Author(s):

Min Ki Hong ◽

Dong Chul Lee ◽

Min Suk Choi ◽

Sung Hoon Koh ◽

Jin Soo Kim ◽

...

Keyword(s):

Pearson Correlation ◽

Demographic Data ◽

Donor Site ◽

Free Flaps ◽

No Donor ◽

Long Term Follow Up ◽

Fingertip Reconstruction ◽

Second Toe

Background The introduction of the partial second toe pulp free flap has enabled superior aesthetic and functional results for fingertip reconstruction in adults. Children undergoing fingertip amputation for various reasons have limited options for reconstruction. Conventional treatment could shorten the finger, leading to poor cosmesis and function. We report 18 years of our experiences with fingertip reconstruction using partial second toe pulp free flaps in patients in early childhood.Methods Medical charts of children who had undergone fingertip reconstruction using partial second toe pulp free flaps from 2001 to 2018 were retrospectively reviewed. The surgical procedures were identical to those for adults, except for the usage of 11-0 nylon sutures. Patients’ demographic data, vessel size, flap dimensions, length of the distal phalanx, and functional outcomes over the course of long-term follow-up were documented. The statistical analysis was performed with the Student t-test, the Mann-Whitney U test, and Pearson correlation analysis.Results Eighteen toe pulp flaps in 17 patients (mean age, 3.0 years) were identified. All the flaps survived without any major complications. In long-term follow-up, the flap-covered distal phalanges showed growth in line with regular development. There was no donor-site morbidity, and all children adapted to daily life without any problems. In two-point discrimination tests, the fingertip sensation recovered to almost the same level as that in the contralateral finger.Conclusions Partial second toe pulp free flaps are an excellent option for fingertip reconstruction in young children, as well as in adults.

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Donor site of toe transfer: IS combined second and third toe transfer the better choice? A 31 years of long-term follow-up

Microsurgery ◽

10.1002/micr.22268 ◽

2014 ◽

Vol 34 (6) ◽

pp. 500-501 ◽

Cited By ~ 2

Author(s):

Michele Maruccia ◽

Kidakorn Kiranantawat ◽

Matthew Sze-Wei Yeo ◽

Fabio Nicoli ◽

Pedro Ciudad ◽

...

Keyword(s):

Donor Site ◽

Long Term Follow Up ◽

Toe Transfer

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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