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Autogenic heterotopic vascularized proximal interphalangeal joint transplantation in children
1Institute of Reconstructive Plastic Surgery, New York University Hand Service, New York University Langone Medical Center, NY 10016, USA. DTWC@davidchiumd.com
Insights
Restoring function in children with complex hand injuries is vital. Vascularized toe joint transplantation effectively reconstructs damaged proximal interphalangeal (PIP) joints, even with flexor tendon injury.
Area of Science:
- Orthopedic Surgery
- Pediatric Hand Surgery
- Reconstructive Microsurgery
Background:
- The proximal interphalangeal (PIP) joint is critical for finger function.
- Complex hand injuries in children necessitate maximal functional restoration.
- Surgical reconstruction is indicated for irreparable PIP joint damage.
Observation:
- Autogenic heterotopic vascularized toe joint transplantation offers composite tissue transfer (skin, tendons, bone, joint, growth plate).
- Previous suggestions indicated a need for intact flexor tendons for successful toe joint transfers.
- This report details a 7-year-old boy with a complex right hand defect including PIP joint comminution and flexor/extensor avulsion.
Findings:
- A staged reconstruction including vascularized toe joint transplantation achieved complete functional restoration.
- The procedure's efficacy was demonstrated in a pediatric case with extensive soft tissue and tendon loss.
- Contrary to prior suggestions, satisfactory results were obtained despite flexor tendon avulsion.
Implications:
- Vascularized toe joint transplantation is a viable option for complex pediatric PIP joint reconstruction, even with tendon damage.
- This technique allows for composite tissue transfer, potentially improving functional outcomes in challenging hand injuries.
- The findings challenge previous assumptions regarding the necessity of intact flexor tendons for successful toe joint transplantation in children.
Abstract:
The proximal interphalangeal joint (PIP) joint is the most crucial joint for the functionality of a finger. For a child with complex injury of the hand every effort should be exercised to maximize function restoration. If the PIP joint is irreparably damaged, its reconstruction is indicated. The technique of autogenic heterotopic vascularized toe joint transplantation provides unique advantage of a composite transfer of skin, tendons, bone and joint alone with growth plate and its efficacy has been affirmed in children. It has been suggested that such transfers require intact flexor tendon to achieve satisfactory results, our experience however indicates quite the contrary. As evidenced by this report of a 7-year-old boy with abrasion and avulsion injury to his dominant right hand resulting in a complex defect with skin lose, extensor, flexor avulsion along with cominution of the PIP joint of his long finger. A surgical formulation of staged reconstruction scheme including an autogenic heterotopic vascularized toe joint transplantation led to complete functional restoration to his right hand.
