Reversed vascularized second metatarsal flap for reconstruction of Manske type IIIB and IV thumb hypoplasia with reduced donor site morbidity

Tong, Dedi; Wu, Lehao; Li, Pengcheng; Rong, Yanbo; Liu, Bo; Lee, WPAndrew; Wei, Qipei; Liu, Lu; Miao, Hejia; Chen, Shan-Lin

doi:10.1097/cm9.0000000000000477

Cited by 12 publications

(11 citation statements)

References 26 publications

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“…The defining feature of Grade 3B and 4 (and some Grade 3A) hypoplastic thumbs is the deficient CMC joint due to proximal metacarpal hypoplasia or aplasia and the accompanying major skin deficiency. We address the osseous deficiency by augmenting it with a toe metatarsal, placed in a reversed manner (Tong et al., 2019). The metatarsal head thus articulates with the trapezium, forming a saddle joint that resembles the CMC joint both in location and configuration.…”

Section: Refining the Methods Of Metatarsal Transfer: Our Experiencementioning

confidence: 99%

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Revisiting the management of Manske Type 3B and 4 thumb hypoplasia

Bai

Chen

2020

J Hand Surg Eur Vol

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The traditional management of Manske 3B and 4 thumbs is index finger pollicization. Recently, the transfer of composite tissues from the foot to reconstruct the thumb or the carpometacarpal joint has allowed the preservation of a five-digit hand. Concerns remained about the donor site and also the limited functional and cosmetic outcomes that could be achieved. This article challenges the existing dogma in the management of hypoplastic thumbs, that pollicization should always be the reference standard. We describe the evolution of techniques with free vascularized metatarsal transfer, our refinements and our proposal for a new classification system that accommodates these modifications. With increased experience, acceptable outcomes that are comparable with pollicization can be achieved.

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Section: Refining the Methods Of Metatarsal Transfer: Our Experiencementioning

confidence: 99%

“…The outcomes for the majority of patients in the vascularized group were discussed in the report of Tong et al. (2019) and the non-vascularized group by Liu et al.…”

Section: Patients and Outcomesmentioning

confidence: 99%

Revisiting the management of Manske Type 3B and 4 thumb hypoplasia

Bai

Chen

2020

J Hand Surg Eur Vol

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“…We agree that toe transfer is a valuable and viable alternative to pollicization, although there remain concerns about the donor site morbidity. That was why our recent technical refinements using a hemimetatarsal were aimed to limit the donor site morbidity (Liu et al, 2020;Tong et al, 2019). In these refinements, split hemi-metatarsals are used to reconstruct the harvested metatarsal, so that the bony architecture of the forefoot remains ultimately unchanged and hopefully ambulation would be unaffected.…”

Section: Referencesmentioning

confidence: 99%

Re: Liu et al. Revisiting the management of Manske Type 3B and 4 thumb hypoplasia. J Hand Surg Eur. 2021, 46: 21–9

De¹,

Chong²,

Liu³

et al. 2021

J Hand Surg Eur Vol

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“…Surgical details had previously been described in previous articles. [14,15] The toe harvest and reconstruction of donor foot is further elaborated here. The hypoplastic thumb was pulled after surgical preparation to measure the length of the bone defect at the recipient site.…”

Section: Surgical Techniquementioning

confidence: 99%

“…We have previously published the results [14,15] of reconstructing the rst metacarpal in patients with Manske type B and thumb hypoplasia using a non-vascularised graft of full-width fourth MT or vascularised graft of full-width second MT; the donor bone defect was lled with a hemi-width graft of the third MT. Thus, the aim of this study was to evaluate the outcome of the donor foot in our patients, after full-width transfer of the second or fourth MT for Manske type B and thumb hypoplasia.…”

Section: Introductionmentioning

confidence: 99%

Donor Site Evaluation after Full-Width Metatarsal Transfer for Metacarpal Reconstruction in Severe Thumb Hypoplasia: A Clinical Retrospective Study

Bai

Liu

et al. 2021

Preprint

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Background: Pollicization remains the default treatment for severe thumb hypoplasia, while the metatarsal transfer is an effective choice for metacarpal reconstruction, with competitive outcome of reconstructed thumb. However, rare researches focused on the outcome of donor foot of the metatarsal transfer. The purpose of this study was to evaluate the short-term outcome of donor foot after full-width metatarsal transfer for Manske Type IIIB and IV thumb hypoplasia.Methods: Fourteen patients with Manske Type IIIB and IV thumb hypoplasia were enrolled in the study. A full-width metatarsal graft (vascularised, from the second metatarsal or non-vascularised, from the fourth metatarsal) was harvested; an adjacent half-width graft from the third metatarsal was transposed horizontally to replace the donor defect. Objective and subjective evaluations were performed at least 12 months postoperatively. The appearances of the toes and the radiographic findings of the metatarsals were evaluated by two authors, the length and width of the metatarsals were measured on digital anteroposterior radiographs using a paired sample t test. The parental satisfaction was evaluated using a self-administered questionnaire. Results: Among these 14 patients (eight type ⅢB and six type Ⅳ thumbs), there were ten male and four female patients. The mean age at operation was 34.2 months (range: 14 to 127 months), and the mean follow-up was 16.1 months (range: 12 to 30 months). Toe lengthening, toe overriding, and synostosis between the metatarsals were observed in two, two and two patients; toe shortening, toe deviation, metatarsal lengthening and metatarsal angulation were observed in one, one, one and one patient. The lengths of third and fourth metatarsals in donor site were significantly larger than those in contralateral side, while the widths of third and fourth metatarsals were not significantly different between donor and contralateral sides. The mean score in the parental satisfaction questionnaire (full score, 30) was 27.2, (range: 17 to 30), which rated as “good”. Conclusions: Following full-width metatarsal transfer for Type IIIB and IV thumb hypoplasia, transposition of the adjacent half-width metatarsal for donor reconstruction results in minor donor deficit and overall parenteral satisfaction. Level of evidence: Ⅳ

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Reversed vascularized second metatarsal flap for reconstruction of Manske type IIIB and IV thumb hypoplasia with reduced donor site morbidity

Abstract: Supplemental Digital Content is available in the text

Cited by 12 publications

References 26 publications

Revisiting the management of Manske Type 3B and 4 thumb hypoplasia

Revisiting the management of Manske Type 3B and 4 thumb hypoplasia

Re: Liu et al. Revisiting the management of Manske Type 3B and 4 thumb hypoplasia. J Hand Surg Eur. 2021, 46: 21–9

Donor Site Evaluation after Full-Width Metatarsal Transfer for Metacarpal Reconstruction in Severe Thumb Hypoplasia: A Clinical Retrospective Study

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