An Alternative Thumb Reconstruction by Double Microsurgical Transfer From the Great and Second Toe for a Carpometacarpal Amputation

Oña, Ignacio Roger de; Villanueva, A. García; Oya, Alexis Studer de

doi:10.1016/j.jhsa.2018.03.022

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…6 Toe PIP or MTPj transfers have been used in finger reconstruction, especially in children 6,7 and for thumb carpometacarpal joint reconstruction. 8 The use of vascularized joint transfers for reconstructing medium-sized joints has been rarely reported, [9][10][11][12] and it is limited by the small size of available expendable donor joints (basically toe MTPjs). The use of a less expendable donor joint, the distal radioulnar joint, has been described as a pedicled vascularized transfer for radiocarpal reconstruction, with questionable risk-benefit ratio.…”

Section: Discussionmentioning

confidence: 99%

Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer

Cavadas,

Padial

2023

Plastic and Reconstructive Surgery - Global Open

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Background: Destruction of the radiocarpal and midcarpal joints causes loss of wrist motion, pain, and reduced grip strength. A novel technique for radiocarpal reconstruction is presented. Methods: Two patients who had radiocarpal and midcarpal destruction and osteoarthritis underwent reconstruction using simultaneous bilateral microvascular second metatarsophalangeal joint transfer. The insetting was performed, inverting the distal-proximal orientation of both metatarsophalangeal joints and fixing them with two 2.0 screws in proximal and Kirschner wires in distal. Results: Radiocarpal extension and flexion without pain were preserved after a minimum of 4 years follow-up. Both patients could return to recreational activities. No secondary procedures were needed. Conclusions: This technique could be an alternative for radiocarpal reconstruction, although longer follow-up and more cases are needed.

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Section: Discussionmentioning

confidence: 99%

Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer

Cavadas,

Padial

2023

Plastic and Reconstructive Surgery - Global Open

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“…The basic elements of an adequate thumb reconstruction are to have a suitable length, a large web space, the sensation of the fingertip, and appropriate position. These combined with being able to oppose the fingers to pinch and grasp are the main determinants of positive outcomes [8,12].…”

Section: Discussionmentioning

confidence: 99%

A Demonstration of Long-Term Outcomes in a Case of Toe to Thumb Transfer Following Traumatic Amputation

Melhuish¹,

Jervis²,

Melhuish³

2021

Cureus

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The thumb is pivotal to many functions of the hand. Loss or absence of the thumb can be catastrophic to a patient’s functioning. Different methods can be employed to surgically fashion a new thumb. This case report aims to demonstrate one patient’s 34-year experience, reporting objective measures for a toe to thumb transfer, and documenting aesthetic outcomes. A semi-structured interview was conducted to gain insight into the patient's personal experiences. Validated assessment tools were used to assess range of movement and power, including Kapandji test, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Cochin Hand Function Scale, Qingfeng Hand Dynamometer, Self-Administered Foot Evaluation Questionnaire (SAFE-Q). A physical examination on the neothumb was performed, along with photography to document aesthetic outcome. A 55-year-old white British male injured his right thumb whilst on a placement year in a sugar refinery in the Netherlands. The thumb was traumatically amputated proximal to the metacarpophalangeal joint. The patient lived for a year without a thumb on his dominant hand, which had a huge effect on his functioning, with extensive input from physiotherapists to help increase his handgrip strength. He then underwent a transfer operation, with the removal of the second toe which was transferred to create a right neothumb. The patient has high physical functioning of his neothumb, however, he is still mildly limited due to pain 34 years post-operation. The objective assessment tools demonstrate a high functioning of the neothumb, with only mild deficits in the dexterity and the physical functioning of the right hand. He experiences mild pain and reduced function of the donor foot. Light touch was found to be absent on the right thumb, but present on the left. Two-point discrimination was 7 mm on the right thumb, and 0.5 mm on the left. In this case, we present a toe to thumb transfer that had very good outcomes after 34 years with few complications. This case demonstrates that great adaptation can occur over long periods of time, restoring near-normal function. Measures of functional outcomes were generally high, with main deficiencies in fine motor skills such as picking up a penny from a flat surface and undoing small buttons. Additionally, there can be good long term outcomes from toe to thumb transfer despite moderate impairment of function. There is hope that this can be used to encourage and reassure patients and surgeons alike that the neothumb is likely to give good outcomes both functionally and aesthetically for many years.

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“…There are two main parameters to be considered during the choice and preparation of the feeding vessel in the recipient area: the proper diameter and high intensity of the bloodstream [14,15]. The wrong evaluation of these parameters in children led to post-operational vascular complications in children caused by insufficient blood circulation in the autograft.…”

Section: Diagram 2 Variants Of Blood Supply Of Toe Autografts In Patmentioning

confidence: 99%

Architectonics of the Vessels Supplying Autograft of the Long Toe, and Options for Their “Connection” to the Recipient Vessels When Transplanted to the Hand in Children

Golyana¹,

Grankin²

2019

MPSES

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The aim of the study was to show the significance of investigating the microvascular structure of the donor and recipient regions for successful microsurgical autotransplantation of toes in children. Materials and methods. From 2000 to 2018, 541 children aged from 8 months to 17 years with congenital and acquired pathology of the upper limb were examined and treated at the RCOI [Research Children's Orthopaedic Institute] n.a. G.I. Turner. A total of 696 autografts were transpositioned. Results. Based on the data of this study, we revealed that the graft of the long toe can be supplied from the system of both the anterior tibial artery, and posterior tibial artery. If the dorsal artery of foot is preserved in the distal direction, the sources of blood supply to the long and third toes may be the dorsal and plantar metatarsal arteries. In cases where the dorsal artery of foot and dorsal metatarsal artery 1 were well developed, different combinations of the finger supplying arteries were noted. When the dorsal metatarsal artery was absent or severely hypoplastic, the autograft was isolated on the plantar metatarsal arteries. The main parameters determining the source of blood supply to the graft were adequate diameter and high blood flow intensity. During the study, we found that in the case of blood supply to the graft from the anterior tibial artery (79%), a well-developed dorsal metatarsal artery was determined in 68%, while in 32% of cases the blood supply to the graft was performed only through the plantar metatarsal arteries. Conclusions. The technique of surgical isolation of the toe autografts remains unchanged and does not depend on the options of angioarchitectonics of the donor region. The survival of the transpositioned microvascular autograft depends on the quality of vessel mobilisation in the donor region and preparation the vessels in the recipient region.

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An Alternative Thumb Reconstruction by Double Microsurgical Transfer From the Great and Second Toe for a Carpometacarpal Amputation

Cited by 15 publications

References 10 publications

Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer

Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer

A Demonstration of Long-Term Outcomes in a Case of Toe to Thumb Transfer Following Traumatic Amputation

Architectonics of the Vessels Supplying Autograft of the Long Toe, and Options for Their “Connection” to the Recipient Vessels When Transplanted to the Hand in Children

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