Nonvascularized Toe Proximal Phalanx Transfers in the Treatment of Aphalangia

James, Michelle A.; Durkin, Robert C.

doi:10.1016/s0749-0712(21)00137-2

Cited by 15 publications

(4 citation statements)

References 31 publications

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“…After the removal of duplicates, two reviewers independently screened titles and abstracts of 423 studies, of which 371 studies were excluded due to prede ned inclusion and exclusion criteria. Of the remaining 52 full texts reviewed, 29 studies were excluded: of which 18 were reviews or surgical technique descriptions without information on the outcome (1,2,14,19,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), 6 thereof were case reports (37)(38)(39)(40)(41)(42), two studies were written in another language than English, German or French (43,44), two studies reported on ndings from the same study population (45,46), and 1 study was excluded as it involved animals (47).…”

Section: Resultsmentioning

confidence: 99%

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Correction of Symbrachydactyly A systematic review of surgical options

Bartsch

Nikkhah

Miller

et al. 2023

Preprint

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Background: There are numerous treatment options available for Symbrachydactyly, a condition with a large spectrum of severity, such as a non-vascularized toe-phalanx transfer, a vascularized toe-to-hand transfer, web-syndactyly release, and distraction lengthening. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes. Methods: The review was performed according to the PRISMA guidelines. Literature was systematically assessed up to 12/2021. Studies were identified using synonyms for ‘symbrachydactyly’ and ‘treatment’. Results: 23 studies published between 1988 and 2021 were included with 539 patients (1037 digit corrections). 8 studies looked at non-vascularized toe to hand transfer, 8 covered vascularized toe to hand transfer, 5 examined distraction osteogenesis only, and 3 exclusively looked at web release. No clear strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates. Non-vascularized transfer demonstrate higher donor site complications, whereas vascularized transfers show higher vascular complication and revision rates in the hand. Conclusion: Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactly due to inadequate study designs and comparative studies. Based on the available evidence we suggest a treatment protocol. As an alternative perspective, it is important to mention that tissue engineering and regenerative medicine might provide alternative surgical solutions in the future, overcoming the issues of morbidity at harvest site and limited supply of autologous phalanges. Systematic review registration: National Institute for Health Research PROSPERO International prospective register of systematic reviews Nr: CRD42020153590

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Section: Resultsmentioning

confidence: 99%

“…Surgery at a younger age results in less bone resorption(58), and the transplanted toe phalanx physis is more likely to remain open in younger patients (10,68). Yet, all ages show disappointing phalangeal growth after transfer (42,58,69).…”

Section: Surgicalmentioning

confidence: 99%

Correction of Symbrachydactyly A systematic review of surgical options

Bartsch

Nikkhah

Miller

et al. 2023

Preprint

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“…The suggested options of management range from no reconstruction (Murray and Shore, 1972) to complex microvascular toe transplantations (Lister and Scheker, 1985). Parents should be counselled early that appearance cannot be restored to normal in most of the cases of aphalangia and that enhancing function will be the primary goal of any active treatment (James and Durkin, 1998). The realistic expectation is that the appearance immediately postoperatively will be more or less maintained as the child's hand grows.…”

Section: Discussionmentioning

confidence: 99%

Non-Vascularized Free Toe Phalanx Transplantation in the Treatment of Symbrachydactyly and Constriction Ring Syndrome

Gohla

Metz

Lanz

2005

Journal of Hand Surgery

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Forty-eight patients underwent a total number of 113 non-vascularized free toe phalanx transplantations for congenital short digits between 1975 and 2003, a mean number of 2.3 transplanted phalanges per patient. The mean age at the time of initial surgery was 3.6 years (range 6 months to 21 years). The follow-up time ranged from 4 months to 14 years with a mean of 6 years. Sixty-four phalanges showed radiographically measured growth, 22 phalanges showed signs of resorption, while 27 phalanges showed neither growth nor resorption. Resorption increased with patient age. Three patients developed donor site problems. The optimum timing for initial surgery is as early as possible because of the safer and greater growth potential and less resorption of the transplanted phalanges. Non-vascularized free toe phalanx transplantations offer a simple and safe method of lengthening with a significant improvement of hand function.

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“…All of these studies, including ours, rely on the presence of a radiolucent area in the physeal region to determine physeal patency. However, such radiolucent tissue in the physeal region does not necessarily correlate with physeal function (James and Durkin, 1998).…”

Section: Discussionmentioning

confidence: 97%

Long Term Follow-Up of Composite Non-Vascularized Toe Phalanx Transfers for Aphalangia

Tonkin

Deva

Filan

2005

Journal of Hand Surgery

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The results of 21 non-vascularized toe phalanx transfers in 13 patients were reviewed radiologically with respect to function, physeal patency, growth and donor site morbidity at a mean follow-up of 7.4 (range 2.9-13.6) years. Physeal patency was maintained in 4 of 18 surviving transfers. The length of the transferred phalanx averaged 75% of the contralateral comparable toe phalanx and 44% of the contralateral digit proximal phalanx. Most patients had good or simple use of the hand with active joint motion. There was universal shortening of the donor toe with hypoplasia of the middle and distal phalanges. This review suggests that transfer of a non-vascularized toe phalanx provides a reliable but limited means for increasing length of a digit, stabilizing soft tissue "nubbins" and improving function. Longer follow-up has shown more modest gains in growth than in some previous reports.

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Nonvascularized Toe Proximal Phalanx Transfers in the Treatment of Aphalangia

Cited by 15 publications

References 31 publications

Correction of Symbrachydactyly A systematic review of surgical options

Correction of Symbrachydactyly A systematic review of surgical options

Non-Vascularized Free Toe Phalanx Transplantation in the Treatment of Symbrachydactyly and Constriction Ring Syndrome

Long Term Follow-Up of Composite Non-Vascularized Toe Phalanx Transfers for Aphalangia

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