Tendon Transfers for the Hypoplastic Thumb

Wall, Lindley B.; Goldfarb, Charles A.

doi:10.1016/j.hcl.2016.03.012

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…The thumb is the most vital part of hand function. The ideal thumb reconstruction from a microsurgical toe transfer should meet the requirements of both form and function with minor donor site morbidity [ 11 – 13 ]. Currently, there are four main types of free toe transfers (total great toe, second toe, great toe wrap around, and trimmed great toe) [ 8 , 12 , 14 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

Yin

Tao

et al. 2020

J Orthop Surg Res

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Background Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe, and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor esthetics. Great toe transplantation achieves better esthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and esthetic satisfaction in thumb reconstruction. Methods We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalanx transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). Results One patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and esthetic results of both the donor and the recipient sites were satisfactory. Results show that, for patients with traumatic thumb defects, the combined transfer of flap and second toe phalanx was the best option. Conclusions Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and second toe phalanx achieved a substantially better functional and esthetic result in the thumb reconstruction.

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Section: Discussionmentioning

confidence: 99%

Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

Yin

Tao

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…The thumb is the most vital part of hand function. The ideal thumb reconstruction from a microsurgical toe transfer should meet the requirements of both form and function with minor donor site morbidity [11][12][13]. Currently, there are four main types of free toe transfers (total great toe, second toe, great toe wraparound, and trimmed great toe) [8,12,[14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Cosmetic and Functional Results of a Newly Reconstructed Thumb by Combining the Phalange of Second Toe and the Great Toenail Flap Transplantation

Yin

Tao

et al. 2020

Preprint

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BACKGROUND Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor aesthetics. Great toe transplantation achieves better aesthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and aesthetic satisfaction in thumb reconstruction.METHODS We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalange transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). RESULTS 1 patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and aesthetic results of both the donor and the recipient sites were satisfactory.CONCLUSIONS Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and 2nd toe phalange achieved a substantially better functional and aesthetic result in the thumb reconstruction.

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“…Therefore, surgical intervention may be delayed until the patient is larger and these structures are more readily palpated. The presence of a trapezium, and thus a stable CMC joint, suggests that the patient may be able to undergo a reconstructive procedure, a tendon transfer (ie, opponensplasty), to gain acceptable function of his or her thumb . This procedure is a less extensive operation than a pollicization procedure, in which the index finger is moved to the position of the thumb, and is required in those patients with a small or absent trapezium and an unstable CMC joint .…”

Section: Discussionmentioning

confidence: 99%

“…Patients with type IIIA hypoplasia have a hypoplastic metacarpal and a stable first CMC joint, whereas patients with type IIIB have a hypoplastic or partially aplastic metacarpal and an unstable first CMC joint. Those patients with type IIIA thumb hypoplasia can undergo a tendon transfer (ie, opponensplasty) to achieve near‐normal thumb function, whereas patients with type IIIB require much more extensive pollicization surgery, in which the index finger is moved to the position of the thumb, to achieve acceptable thumb function . Currently, surgeons rely heavily on the physical examination to assess whether the CMC joint is stable; however, the findings are not always definitive.…”

mentioning

confidence: 99%

“…Those patients with type IIIA thumb hypoplasia can undergo a tendon transfer (ie, opponensplasty) to achieve near-normal thumb function, whereas patients with type IIIB require much more extensive pollicization surgery, in which the index finger is moved to the position of the thumb, to achieve acceptable thumb function. 8,9 Currently, surgeons rely heavily on the physical examination to assess whether the CMC joint is stable; however, the findings are not always definitive. Ultrasound is an attractive modality for visualizing the trapezium, which is absent or small in cases of first CMC joint instability and is usually near normal in size and morphologic characteristics in cases in which the first CMC joint is stable.…”

mentioning

confidence: 99%

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Feasibility of Ultrasound in Infant Wrist and Thumb Imaging

Milks¹,

Warren²,

Popp

et al. 2018

J of Ultrasound Medicine

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Objectives To determine the feasibility of ultrasound (US) in infant lateral carpal and base‐of‐the‐thumb imaging. We hypothesized that US would be a practical modality for visualizing the unossified structures. Methods Institutional review board approval was obtained for this single‐center pilot study. Healthy infants aged 12 months or younger were enrolled. Ultrasound examinations of the distal radial epiphysis through the first metacarpal were performed with a high‐frequency transducer. Results Ultrasound evaluations of the base of the thumb were performed in 18 healthy infants (mean age ± SD, 13.8 ± 9.1 weeks; 44% female). Assuming an elliptical shape, the mean areas of the scaphoid and first metacarpal epiphysis measured 0.85 ± 0.19 and 0.44 ± 0.087 cm2, respectively. The mean areas of the trapezium and ossified first metacarpal as approximate rectangular shapes measured 0.23 ± 0.069 and 0.49 ± 0.16 cm2. A perimeter tracing was also used as an alternative area calculation. The mean trapezium area–to–scaphoid area ratio (0.28 ± 0.10) showed less variability compared to the first metacarpal epiphysis area–to–scaphoid area ratio (0.55 ± 0.20) or first metacarpal area–to–scaphoid area ratio (0.64 ± 0.31). Conclusions Our data suggest that US is well suited for the evaluation of the lateral carpus and base of the thumb in young infants. These data serve as a reference to which wrist and thumb abnormalities can be compared.

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Tendon Transfers for the Hypoplastic Thumb

Cited by 5 publications

References 20 publications

Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

Cosmetic and Functional Results of a Newly Reconstructed Thumb by Combining the Phalange of Second Toe and the Great Toenail Flap Transplantation

Feasibility of Ultrasound in Infant Wrist and Thumb Imaging

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