Technical keys in maximizing finger proximal interphalangeal joint motion after vascularized toe joint transfers

Abstract

Vascularized toe joint transfers to the fingers have been performed for more than four decades, but their outcomes are not comparable with implant arthroplasty. Limited range of motion and extensor deficits of about 30° remain major problems with the constructed joints. We observed that the central extensor tendon of the toe is often attenuated proximally in its course on the dorsum of the proximal interphalangeal joint. A tight repair of the toe extensors to finger extensors limits joint motion. We reviewed our surgical techniques with this consideration. Thirty-eight fingers that we followed for 6 to 123 months had active range of motion of the reconstructed proximal interphalangeal joint in the finger of 58° (range 17°–76°) with an extensor deficit of 18° (range 0°–30°). We consider that the extensor mechanism and central slip insertion to the middle phalanx must be reconstructed meticulously to improve joint motion and decrease extension lag, and design of a lateral skin flap paddle to better cover vessels and allow extensor repairs.

Does Inclination of the Toe Proximal Phalangeal Head Affect the Outcomes of Vascularized Joint Transfers? Retrospective Study of 22 Joint Transfers

“…A type I toe has an attenuated central slip, whereas a type II toe has a strong, visible central slip that clearly extends the proximal interphalangeal joint straight on extension. The frequency of type I toe was 95 percent and the frequency of type II toe was 5 percent 1 (Fig. 1).…”

“…osttraumatic osteoarthritis of the proximal interphalangeal joint is often characterized by symptoms of pain, joint instability, and decreased functional range of motion and power. [1][2][3] Management of severe proximal interphalangeal joint osteoarthritis includes denervation, arthrodesis, implant arthroplasty, and vascularized joint transfer. 2,3 Compared to implant arthroplasty or arthrodesis, vascularized joint transfer from the foot has its own advantages, which include the ability to reconstruct the finger proximal interphalangeal joint with composite tissue defects.…”

Toe-to-Finger Vascularized Joint Transfers for Proximal Interphalangeal Joint Reconstruction: A Systematic Review

“…Second, the metaphyseal and epicondylar branches of the digital artery, which provide vascular supply to the proximal and middle phalanx, respectively, are protected by the medially oriented skin paddle. 8…”

“…3 In comparison, “type 2” toes possess a thicker tendinous insertion which is analogous to the central slip seen in the fingers. Intra-operative dissection of over 90 VJTs by Lin 8 has found the incidence of type 1 and type 2 toes to be 94% and 6%, respectively.…”

“…3 For type 2 toes, tenorrhaphy is performed at Zone 4 directly between the extensor digitorum longus and extensor digitorum communis via a Pulvertaft weave. 8 VJTs utilizing this clinical algorithm have seen promising results with improvements in postoperative functional outcomes. 3,8,10…”