Microvascular reconstruction of congenital anomalies and post-traumatic lesions in children

A series of toe-to-hand transfers in children with congenital or post-traumatic deficits is reported to emphasize the role of microvascular reconstruction as an important alternative. Morbidity to the donor site is almost negligible, and the functional improvement to the hand is reasonably good considering the young age of the patients. Functional results are limited by the lack of full motion, soft-tissue contractures, sensory recovery, and the delay in cortical reeducation. We were surprised to find a relatively high number of vascular anomalies in the foot (both traumatic as well as congenital). Abnormalities in the transferred toe can limit the function of the hand, and the best (not worse) tissues available should be transferred. The importance of digit positioning to provide prehensile pinch and grasp as the ultimate goal needs to be emphasized so that opposing fingers rather than cosmetic fingers result in effective hand use. We recommend this operative procedure in selected patients along with other reconstructive alternatives, taking care in the selection process to consider factors related to both asthetic improvement of the hand as well as long-term functional return.