[The vascularized articular transfers from the foot]

Complete destruction of the PIP or MCP joint space can be treated by a vascularized transfer from the foot in selected patients. The surgical technique for PIP and MTP vascularised transplantation is described with special emphasis on recent improvements (use of a short vascular pedicle, refinements in donor site reconstruction). Results of a series of 50 transfers performed between 1992 and 2009 are presented. PIP transfer was performed in 37 patients, at an average age of 18.3 years (range 3 to 40) leading to an average active ROM of 44° (0-80), with a lag of extension of 34.2° (0-80). MCP transfer was performed in 12 patients (13 transfers), at an average age of 21.3 years (range 3 to 40) leading to an average range of motion of 60° (35-80), with a lag of extension of 18.6° (0-30). None of the reconstructed articulations was painful. On the plain radiographs, no degradation of the joint space of the transferred articulations was noted. Within the pediatric population, the growth potential was preserved, signing the perenniality of the vascularization of the transfers. When faced to a complete joint destruction involving either the PIP or the MCP of the long fingers, reconstruction can be achieved by the mean of a vascularized joint transfer. The range of motion obtained with these transfers is not superior to what is observed after arthroplasty but it will persist with time. Therefore, even it is a technically demanding option, it should remain in our armamentarium as an alternative to joint fusion or joint arthroplasty.