Free Vascularized Toe-Joint Transfer in Hand Reconstruction: A Series of 25 Patients

Abstract

Twenty-eight vascularized toe-joint transfers performed on 25 patients were reviewed. A number of different techniques were used: proximal interphalangeal joint or metacarpophalangeal joint reconstruction, one-stage double joint transfer, and interphalangeal thumb or trapezometacarpal joint replacement. Using these types of vascularized joint transfer allows one-stage composite transfer (including skin, bone, and extensor tendon) and provides rapid bone healing, potential growth in the young, good long-term cartilage preservation, normal lateral stability in pinch, and limited but useful range of motion (mainly at the proximal interphalangeal level).

Single pedicle vascularized double joint transfer: Anatomic study of two models

“…Previously reported techniques of double joint transfer for the reconstruction of two joints in the hand have described transfer of the PIP joints of the second and third toe based on a common plantar digital artery, 9 transfer of the MTP joints of the second and the third toe based on the vessels from the first interosseous space, 12,13 transfer of the PIP joints of the second and third toes based on two separate pedicles from the first and second interosseous spaces, 10 and the separation of the PIP and MTP joints of the second toe in a transfer procedure based on the common pedicle of the first and second metatarsal arteries. 10 In the first two methods, the transferred joints need to be harvested as a block.…”

“…10 In the first two methods, the transferred joints need to be harvested as a block. Thus, the indication would be limited to the reconstruction of two adjacent joints in the hand.…”

“…[10][11][12][13] In 1996, Tsai and Lim 14 reported the technique of simultaneous reconstruction of the metacarpophalangeal (MCP) joints of the thumb and index finger by free transfer of the separated metatarsophalangeal (MTP) and proximal interphalangeal (PIP) joints of the second toe based on a single pedicle. The advantages of transferring two joints on a single pedicle are that donor site morbidity is minimized and only a single pair of arteries and veins at the recipient site is required.…”

Autogenic heterotopic vascularized proximal interphalangeal joint transplantation in children

“…These findings provided the impetus for the development of vascularized joint transfers that have proved to be clearly superior to their nonvascularized counterparts. [3][4][5][6] Buncke et al performed the first vascularized island finger joint transfer in 1967. 7 This was followed by Foucher and Merle in 1976 who performed the first autogenic heterotopic vascularized toe joint transplantation.…”

Vascularized bone grafts in trauma and reconstructive microsurgery, part 1

“…Free-vascularized metatarsophalangeal joint has been successfully transferred to the metacarpophalangeal joints, whereas the second toe proximal interphalangeal (PIP) joint has been used to replace a damaged PIP joints of the hand. 23,24 Vascularized joints may be also used from nonreplantable digits for the reconstruction of complex hand injuries. 25 …”