Second toe metatarsophalangeal joint transfer for sternoclavicular joint reconstruction

We describe the anatomical basis for microsurgical reconstruction of the sternoclavicular joint using a vascularized, innervated second metatarsophalangeal joint, the surgical technique, and outcomes in 2 patients.

We harvested the second metatarsophalangeal joint along with the joint capsule, portions of the metatarsal and phalanx, the flexor sheath and flexor tendon, the extensor sheath and tendon, the first metatarsal artery, and the deep peroneal nerve. This composite tissue was used for reconstruction of an excised sternoclavicular joint following infection or chondrosarcoma. The proximal phalanx was dowel-jointed into the manubrium and fixed with 1 or 2 screws; the metatarsal was plated to the remaining clavicle. The joint was oriented to allow maximal elevation and restricted depression, and the normal mediolateral laxity allowed anterior and posterior movement. Vascular anastomoses were performed to branches of the thoracoacromial axis vessels, and digital nerves were connected to a supraclavicular nerve.

Two patients had their excised sternoclavicular joints reconstructed using this technique. Both achieved union at the clavicular and sternal junctions. Both obtained restoration of movement of the sternoclavicular joint and upper limb. One patient developed joint subluxation and pain requiring tendon graft reconstruction of the costoclavicular ligament.

In these 2 cases, the vascularized second toe metatarsophalangeal joint satisfactorily reconstructed the widely excised sternoclavicular joint and costoclavicular ligament and restored function.

Therapeutic IV.