Vascularized Toe Joint Transfer for Hypoplastic Thumb Type IV

Area of Science:

• Pediatric Orthopedics
• Hand Surgery
• Microsurgery

Background:

• Hypoplastic thumb presents challenges in hand function and aesthetics.
• Traditional treatments like pollicization may not be suitable for all cases.
• Unstable carpometacarpal joints require specialized reconstructive approaches.

Observation:

• A 7-year-old girl with Type IV hypoplastic thumb, characterized by instability and lack of function, was treated.
• Preoperative assessment revealed a 'floating thumb' without a first metacarpal bone.
• A vascularized metatarsophalangeal joint from the contralateral second toe was utilized for reconstruction.

Findings:

• The surgical procedure involved transferring a vascularized toe joint, preserving the existing thumb structures.
• Microsurgical anastomosis of the digital artery and dorsal veins was performed.
• Post-operative follow-up at 9 months demonstrated a reconstructed five-digit hand with a stable, opposable thumb.

Implications:

• Vascularized toe joint transfer successfully restores thumb function, including opposition to the little finger.
• The inclusion of the epiphyseal plate allows for potential future thumb growth.
• The procedure resulted in high patient and parent satisfaction due to improved function and aesthetics.