Microsurgical toe-to-hand transfer in children with macrodactyly of the hand

Abstract

Background. At present, there are multiple approaches to the treatment of macrodactylia in children. Additionally, there are no comparative data on the cosmetic and functional aspects of corrective surgery versus microsurgical transplantations performed in children with a marked disproportion of the segment, making this study particularly relevant.
 Aim. The aim of this study was to determine the role of microsurgical transplantation of the toes in the treatment of children with isolated macrodactylia, based on a comparative analysis of various surgical interventions.
 Materials and methods. Twenty-five children with congenital macrodactylia of the hand were examined and surgically treated in the department of reconstructive microsurgery from 2013 to 2017. Of these, 13 (52%) had macrodactyly of the 2nd and/or 3rd fingers, and of the total number of hyperplastic hand segments (n = 45), 17 rays had hyperplasia greater than 25%.
 Results and discussion. Stage-by-stage modeling resections of enlarged segments were performed in all children with ray hyperplasia that was about 25% of the size of intact fingers. In 4 cases, excision of soft tissues was combined with marginal resection of phalanges. When hyperplasia of the segment reached up to 10% of macrodactylia, single isolated modeling resection of soft tissues and bones was performed. Repeated modeling plasties in 16% (n = 4) of the children were accompanied by gross postoperative scars with the development of secondary angular deformities and loss of function of interphalangeal joints.
 Nine children (n = 14) underwent amputation of hyperplastic fingers followed by microsurgical reconstruction of rays by autografting of toes. In 4 cases, the first finger was reconstructed, and in the other 5 cases, toes of both feet were transplanted to the positions 2 and 3 (n = 4) or 3 and 4 of fingers (n = 1). It was found that in cases of significant hyperplasia of the affected segments of the hand (hyperplastic segment is 1.5–2 times greater compared to normal ones), microsurgical autografting of toes is more effective and acceptable compared to bone and soft tissue resections.
 Conclusions. In cases of segment hyperplasia less than 1.25-times the normal size, the optimal surgical interventions are stage-by-stage modeling resections. An alternative surgical treatment for children with hyperplasia of more than 1.25-times the normal size is microsurgical transplantation of the toes in the position of the involved rays of the hand, which results in good cosmetic and functional outcomes in these patients.

Macrodactyly

“…Sophisticated reconstructive techniques allow finger salvage with a decrease in digit size and volume to reach acceptable cosmetic results, e.g., fingertip flap reconstruction with nail downsizing [31]. There are reports on tridimensional preoperative planning, a series of nerve allografts, or amputation followed by toe-to-hand transfer [32][33][34]. This diversity of methods shows that there is no universal treatment strategy.…”

Microsurgical Toe-to-Hand Transfer in Children

“…Кроме того, по мнению многих исследователей, микрохирургическую реконструкцию возможно производить также при врожденных и при приобретенных деформациях кисти у детей разного возраста. Преимуществом данной методики является одномоментное восстановление луча кисти, его двигательной и чувствительной функций, а успех таких операций наблюдается в 94-96% случаев [3][4][5].…”

“…По данным отечественной и зарубежной литературы в раннем послеоперационном периоде основными осложнениями служат нарушения кровоснабжения в аутотрансплантате и развитие воспалительных процессов [3,6,7]. Нарушение микроциркуляции связано с тромбозом сосудов трансплантата либо с механическим сдавлением микрососудистого анастомоза вследствие отека мягких тканей [8][9][10].…”