Improving the Extensor Lag and Range of Motion following Free Vascularized Joint Transfer to the Proximal Interphalangeal Joint

Lam, Wee Leon; Waughlock, Nicholas; Hsu, Chin-Yuan; Lin, Yu‐Te; Wei, Fu‐Chan

doi:10.1097/prs.0b013e31829589db

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…Extension lag is commonly reported and is considered by some to be unavoidable with both vascularized and nonvascularized digital joint transfer. 20,21 There is a natural extension lag of 16° in the second toe PIP joint, while reported postoperative extension lag ranges between 17.1 and 42.5° in vascularized whole toe joint transfers. 20,23 Multiple methods have been described to reinforce the central slip attachment and mitigate attenuation.…”

Section: Discussionmentioning

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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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: 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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“…A cadaveric study of toe PIPJs performed by Lam et al 10 revealed 2 distinct extensor tendon mechanisms. The more common of the two, coined “type 1” toes, are those with an attenuated central slip similar to a thin aponeurosis that lacks a distinct insertion onto the middle phalangeal base.…”

Section: Discussionmentioning

confidence: 99%

“…In an attempt to optimize functional outcomes, Lam et al 10 developed an algorithm (later refined by Loh et al 3 ) focused on dynamic assessment of 3 factors: the donor toe central slip, recipient finger lateral bands, and lumbrical system. Depending on the integrity of the central slip of the donor toe and lateral bands at the recipient PIPJ, the extensor mechanism is either centralized, reconstructed, or repaired directly to the donor extensor tendon.…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Graham

Lawson

et al. 2021

Hand (New York, N,Y.)

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Vascularized joint transfer (VJT) from the proximal interphalangeal joint (PIPJ) of the toe is an attractive reconstructive option in cases of nonsalvageable finger PIPJ but is limited by equivocal functional outcomes. This systematic review aims to provide an update on vascularized toe-to-finger PIPJ transfers, examining functional outcomes, complications, and the latest refinements in operative technique. A systematic review of the available literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining vascularized toe-to-finger PIPJ transfer for post-traumatic indications were included for analysis. Outcomes assessed included postoperative active range of motion, extension lag, and complications. Thirteen studies examining 210 VJTs were analyzed. Five VJTs experienced microsurgical failure giving an overall survival rate of 97.6%. Average postoperative PIPJ active range of motion (ROM) was 40.3° ± 12.9°, with an average extensor lag of 29° ± 10.5° and mean flexion of 68.9° ± 10.9°. For studies reporting complication outcomes, 59/162 complications were seen. No significant differences were seen between studies published prior to 2013 and after 2013 when comparing digital ROM ( P = .123), flexion ( P = .602), and extensor lag ( P = .280). Studies using a reconstructive algorithm based on prior assessment of the donor toe central slip and recipient finger anatomy had significantly improved ROM outcomes ( P = .013). Although VJT provides a reliable option for autologous reconstruction in posttraumatic joints, it is limited by impaired postoperative ROM. Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes.

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“…The MPJ and PIPJ are responsible for most of a digit's ROM, whereas the point of DIPJ preservation is typically to preserve length, and therefore motion is not as significant a concern. 12 Hierner and Berger 6,20,21 proved that there was no significant difference in results between toe joint and heterodigit joint transplantation. Based on our experience, we can classify the heterotopic joint transfer as same level joint transfer, distal to proximal joint transfer, and proximal to distal joint transfer.…”

Section: The Position Of Donor and Recipient Jointmentioning

confidence: 95%

Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries

Chang

Hsu

et al. 2016

Annals of Plastic Surgery

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Improving the Extensor Lag and Range of Motion following Free Vascularized Joint Transfer to the Proximal Interphalangeal Joint

Abstract: Therapeutic, IV.

Cited by 17 publications

References 22 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

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

Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries

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