Vascularized Toe Joint Transfer for Hypoplastic Thumb Type IV

Vascularized toe joint transfer can be an alternative treatment for children who have hypoplastic thumb with unstable carpometacarpal joint and refuse thumb ablation with index pollicization. This procedure can reconstruct a 5-digit hand with stable thumb for opposition. As the viable epiphyseal plate is included in this transfer, the potential for future growth can be expected from this type of reconstruction. This article describes details of the surgical procedures. The outcomes of this reconstruction are shown in a 7-year-old girl who presented with hypoplastic thumb type IV. Initially, her thumb was unstable, nonmobile, and had no function. The skin pedicle of this thumb had a diameter of about 3 mm. Preoperative radiography showed floating thumb without first metacarpal bone. The vascularized metatarsophalangeal joint from the opposite second toe was used for her hypoplastic thumb reconstruction. During the procedure, the flail thumb was preserved. The intraoperative bone gap that was needed for reconstruction was 3.5 cm. The artery was anastomosed with common digital artery from the third web space. Two dorsal veins were joined with the subcutaneous vein at the dorsum of the hand. Total operative time was 6 hours. At the 9-month follow-up, this girl achieved a 5-digit hand with stable thumb that had opposition to the tip of her little finger. She can use this hand to perform all activities of daily living without any pain. Both patient and parents were very satisfied with the functional and cosmetic appearance.