Functional Improvement with Free Vascularized Toe-to-hand Proximal Interphalangeal (PIP) Joint Transfer

Kuzu, İsmail Melih; Kayan, Reşit Burak; Öztürk, Kahraman; Güneren, Ethem

doi:10.1097/gox.0000000000001775

Cited by 11 publications

(16 citation statements)

References 18 publications

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“…However, microsurgery is inherently demanding, and recent studies continue to demonstrate only 24 to 37° of average arc of motion following vascularized toe joint transfer. 1,23,24 In their meta-analysis, Chen et al 23 additionally found no difference in postoperative ROM between children and adults. A retrospective review by Ellis et al suggested postoperative arc of motion was further limited in preadolescent patients (12 years of age or younger), who averaged 24.3° of motion after vascularized toe to finger joint transfer.…”

Section: Discussionmentioning

confidence: 98%

“…In addition, results of vascularized joint transfer continued to experience many of the same functional issues exhibited by nonvascularized transfers such as suboptimal ROM (both extension lag and poor flexion) and diminished long-term growth. [20][21][22][23][24] No highlevel evidence exists that shows consistent growth after either nonvascularized or vascularized toe to finger joint transfer, and growth potential remains largely theoretical.…”

Section: Introductionmentioning

confidence: 99%

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Nonvascularized Toe Joint Transfers to the Hand in Young Children: Technique Revisited

Trost

Kaufman

Netscher

2020

Hand (New York, N,Y.)

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Background: Small joint reconstruction of the hand poses a significant challenge, especially in children where both functional motion and preservation of the epiphysis are desired. Auto-transplantation of whole joints is the only way to reconstruct a functional joint that maintains growth potential. Historically, nonvascularized toe-to-finger joint transfer has been criticized for high rates of avascular necrosis and joint dissolution, while vascularized transfers seemingly resulted in increased durability of the joint space and epiphysis. However, certain populations remain poor candidates for microvascular reconstruction, such as those with congenital deformities or sequelae from trauma or infection. In our case series, we demonstrate that a simplified nonvascularized surgical technique and careful patient selection can produce stable, functional joints. Methods: Nonvascularized toe-to-finger joint transfer was performed in 3 children between the ages of 4 and 6. Reconstructed joints included 2 proximal interphalangeal (PIP) joints and 1 metacarpophalangeal (MCP) joint. Donor grafts consisted of second toe PIP joints harvested en bloc to include the epiphysis of the middle phalanx, collateral ligaments, volar plate, and a diamond-shaped island of extensor tendon with its central slip attachment. Results: Follow-up ranged from 7 to 29 months. Each patient demonstrated functional improvements in joint motion and stability. Postoperative radiographs confirmed adequate joint alignment and persistence of the joint spaces. Epiphyseal closure was observed in 1 patient as early as 25 months postoperatively. Conclusions: Nonvascularized joint transfer should remain a practical consideration for small joint reconstruction of the hand in certain pediatric patients.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Nonvascularized Toe Joint Transfers to the Hand in Young Children: Technique Revisited

Trost

Kaufman

Netscher

2020

Hand (New York, N,Y.)

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“…The transfer of a free vascularized graft from the second proximal interphalangeal joint of the foot remains an alternative for active patients, especially for young patients with open epiphyseal plates 22,23 . However, previous reports suggest that the donor site morbidity of the second proximal interphalangeal joint is significantly higher than the femoral condyle 15,16,23 …”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Fourth Metacarpal Using a Chimeric Medial Femoral Condyle Vascularized Osteochondral Cutaneous Graft

Jorge

Estler²,

Wahler³

et al. 2022

Ann Plast Surg

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Background: The medial femoral condyle has become a matter of great interest, thanks to the possibility of harvesting versatile chimeric flaps for reconstruction of metacarpal defects with minimal donor site morbidity. This case stands out because of the complete reconstruction of the metacarpal head, harvesting with a skin paddle for tension-free closure and monitoring, and the use of external fixation for better predictability of the reconstruction and early postoperative mobilization. Case Presentation: We report the case of a 20-year-old male patient who presented with an aneurysmal bone cyst involving the fourth metacarpal bone. The patient underwent resection en bloc of the metaphysis and distal epiphysis of the fourth metacarpal bone, and the bone defect was reconstructed using a 3.4-cm vascularized osteochondral cutaneous graft from the medial femoral condyle. Results: At 1-year follow-up, the patient showed no impairment in hand range of motion and had a Disabilities of Arm, Shoulder and Hand score inferior to that of the male healthy population. Almost 5 years after the procedure, the radiographic examination did not reveal signs of arthrosis. This case report shows that the medial femoral condyle is an excellent and versatile source of vascularized osteochondral grafts for reconstruction of metacarpal defects.

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“…Based on our experience of free vascularized distal interphalangeal joint flap procedures, we conclude that distal interphalangeal joint flap is a safe and effective procedure for traumatic proximal interphalangeal joint defects without causing damage to the donor toes. This method is deemed superior to conventional proximal interphalangeal joint transfer since less trauma is caused to the donor site [1,[6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Osteoarthritis-related defects of the finger joint can be repaired with temporary replacements, such as implants [1][2][3][4][5], permanent arthrodesis, and vascularized joint grafts like joint flaps or articular flaps [6][7][8][9][10][11]. Among these methods, the best one is believed to be the permanent substitution through an autogenous vascularized joint transfer utilizing the proximal interphalangeal joint of the second toe [6][7][8][9][10][11]. This procedure, however, has the disadvantage that the donor toe becomes deformed and shorter, which has the effect of reducing the range of motion.…”

Section: Introductionmentioning

confidence: 99%

Free Vascularized Second-Toe Distal Interphalangeal Joint Transfer for Reconstruction of Finger Defects

Koshima¹,

Imai²,

Yoshida³

et al. 2021

IMJ

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Objective: Joint defects in the fingers due to osteoarthritis are often repaired with joint implants, arthrodesis or by vascularized proximal interphalangeal joint graft. The disadvantage of grafts, however, is that they may damage the donor toe. As a result of the discussion presented in this paper, we present evidence to indicate that vascularized distal interphalangeal joint transfers from the second toe may be able to be used in the reconstruction of these defects by using microsurgical techniques. Methods:In this study, we have operated on four cases of hand osteoarthritis using the technique. The distal interphalangeal joint of the second toe was transferred as a composite flap including tendons and/or digital artery perforator flap. There was a follow up period of three to fourteen months after the surgery.Results: All patients have gained an improved range of motion and stabilization of their joints. There was no skin necrosis or damage to the donor toes, and the function of the remaining proximal interphalangeal joint was preserved. Conclusion:There is evidence that a distal interphalangeal joint transfer can be a less invasive and effective technique for the reconstruction of traumatic proximal interphalangeal complex defects and advanced carpometacarpal arthritis of the thumb.

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Functional Improvement with Free Vascularized Toe-to-hand Proximal Interphalangeal (PIP) Joint Transfer

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 18 publications

Nonvascularized Toe Joint Transfers to the Hand in Young Children: Technique Revisited

Nonvascularized Toe Joint Transfers to the Hand in Young Children: Technique Revisited

Reconstruction of the Fourth Metacarpal Using a Chimeric Medial Femoral Condyle Vascularized Osteochondral Cutaneous Graft

Free Vascularized Second-Toe Distal Interphalangeal Joint Transfer for Reconstruction of Finger Defects

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