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Osteoplastic thumb ray restoration with or without secondary toe transfer for reconstruction of opposable basic hand
Chih-Hung Lin1, Samir Mardini, Yu-Te Lin
1Taipei, Taiwan; and Rochester, Minn. From the Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, and Department of Plastic Surgery, Mayo Clinic.
Plastic and Reconstructive Surgery
|March 20, 2008
Summary
Osteoplastic thumb reconstruction effectively restores basic hand function for many patients with severe hand injuries. Combining this with toe transfers often leads to optimal functional outcomes and improved opposition.
Area of Science:
- Hand surgery
- Reconstructive surgery
- Orthopedics
Background:
- Mutilating hand injuries cause significant bone and soft-tissue defects.
- Osteocutaneous flaps are a viable option for thumb ray reconstruction.
- Reconstruction can be a definitive procedure or a precursor to toe transfer.
Purpose of the Study:
- To evaluate the effectiveness of osteoplastic thumb ray reconstruction.
- To assess functional outcomes using the Kapandji classification.
- To determine the impact of secondary procedures like toe transfer.
Main Methods:
- Twenty-four patients with thumb amputations underwent osteoplastic surgery.
- The Kapandji classification assessed hand function pre- and post-operatively.
- Patients were evaluated after initial reconstruction and subsequent revisions or toe transfers.
Main Results:
- 54% of initial osteoplastic reconstructions achieved opposition.
- Overall basic hand function was achieved in 83.3% of patients.
- Toe transfers led to an average improvement of 4.1 points on the Kapandji scale.
Conclusions:
- Osteoplastic thumb reconstruction with subsequent procedures can provide satisfactory results.
- Optimal functional outcomes are most likely when osteoplastic reconstruction is followed by toe transfer.
- This approach addresses bone and soft-tissue defects in severe hand injuries.