Outcome Measures of Microsurgical Toe Transfers for Reconstruction of Congenital and Traumatic Hand Anomalies

Abstract

Level III-Therapeutic study.

Symbrachydactyly — Diagnosis, Function, and Treatment

“…The transferred sensate digit will help the hand to independently pinch, grasp, and perform selfcare. 17 The viability of microvascular transfer by experienced surgeons is generally greater than 95%. 27 The child's second toe is transferred to the hand in a single stage as first described by Cobbett 28 and Buncke et al 29 Toe transfer to the symbrachydactyly hand may be challenging.…”

“…16 Early hand reconstruction may facilitate the child's development of pinch and grasp. 17 Many manual skills are developed by the age of 3, including pinch. 18,19 Floppy, unstable digits occur, and in younger children with an unstable interphalangeal joint, chondrodesis, or fusion of the 2 cartilaginous surfaces, may stabilize these digits.…”

Symbrachydactyly

“…Kaplan 36 administered the Pediatric Outcome Data Collection Instrument (PODCI) to 15 children who had toeto-hand transfers and found that scores for self-reports of upper extremity function and transfer/mobility, and parent reports of global function, upper extremity function, and sports/physical function, were lower than normative scores (they did not compare postoperative with preoperative scores). They also found that parents underestimated sports/physical function and happiness compared with the patient reports; this has been shown for other congenital conditions as well.…”

Do Patient- and Parent-reported Outcomes Measures for Children With Congenital Hand Differences Capture WHO-ICF Domains?

“…Of the 19 validated PROMs used in the 42 studies, only the Prosthetic Upper Extremity Functional Index (PUFI) has been validated specifically in the CHD population (children with congenital longitudinal and transverse deficiency) [7,8,22,48]. Only the ABILHAND-Kids Questionnaire, Disabilities of the Arm, Shoulder and Hand (DASH), Pediatric Outcomes Data Collection Instrument, PUFI, and QuickDASH were developed specifically for use in patients with orthopaedic/upper extremity pathology [7,8,22,26,35,44,48,72]. The remaining PROMs were developed and validated as generic adult or pediatric outcomes measures.…”

“…In children who are cognitively impaired or otherwise unable to understand survey items, validated parent-proxy reports are available, and many studies record only parent-reported outcomes data. However, discrepancies between child-and parentreported outcomes have been noted in previous studies with parents either overestimating or underestimating the impact of CHD on their children [2,3,8,10,40,44,55]. One possible way to evaluate the reliability of a proxy report is to administer the exact same PROM in a parallel fashion to both the parental proxy and the child.…”