[Nonvascular phalangeal transfer from toes to hand in congenital aphalangia]

Free transfer of the toe phalanges to the hand without vascular anastomosis is a proposed option for reconstruction of congenital aphalangia. We evaluated the growth behavior of the phalanges in patients after transfer.

Six patients with congenital aphalangia underwent 18 nonvascular phalangeal transfers from toes to the hand. The anomaly was bilateral in one patient. Except for one patient who was 11.5 years old, the mean age at the time of surgery was 27 months (range 14 to 48 months). The patients were followed-up for a mean of 2.5 years (range 2 to 4 years) with respect to functional results, yearly longitudinal growth, epiphysial closure, bone resorption or necrosis, digital tip necrosis, fracture, angulation, subluxation, infections, and donor site morbidity.

The mean yearly longitudinal growth rate of transferred phalanges was 2.4 mm. On final radiographic examinations, epiphysial closure was not completed in 14 phalanges (78%). Functional improvements included stabilization using the affected digit in three patients, and performing further movements in three patients. One patient underwent reoperation for postoperative subluxation. No fractures or angulation above 15 degrees were seen. Bone resorptions were partial in three patients (16%), and total in one patient (5%). Concerning soft tissue complications, digital tip necrosis developed in one patient (5%). No infections were encountered during the follow-up. All the patients exhibited minimal donor digit shortening.

Nonvascular phalangeal transfer is an alternative rehabilitation method by which use of prosthetics may be facilitated and functional capacity may be increased in congenital hand anomalies such as congenital aphalangia, in which vascular phalanx transfer is not suitable.