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Long-Term Outcomes After Toe-To-Thumb Transfers for Burn Reconstruction in Children
1Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, USA.
Insights
Pediatric toe-to-thumb transfers effectively restore function in severely burned hands. This reconstructive surgery offers excellent outcomes for children, preserving donor foot health and improving hand capabilities.
Area of Science:
- Reconstructive surgery
- Pediatric burn care
- Microsurgery
Background:
- Children are highly susceptible to severe burn injuries, particularly affecting the hands.
- Restoring thumb function after extensive burns in pediatric patients presents significant challenges.
- Toe-to-thumb transfer is a reconstructive option for severe hand burn injuries.
Purpose of the Study:
- To evaluate the functional outcomes and complications of pediatric toe-to-thumb transfers for burn reconstruction.
- To assess the long-term efficacy of toe-to-thumb transfers in pediatric patients with severe hand burns.
Main Methods:
- Retrospective review of pediatric patients (under 18) undergoing toe-to-thumb transfers for burn reconstruction between 2009 and 2014.
- Inclusion criteria: secondary reconstruction after thermal or electrical burns, minimum 5-year follow-up.
- Functional outcomes assessed using the modified Kapandji score; donor foot morbidity recorded.
Main Results:
- Ten toe-to-hand transfers were performed on four pediatric patients (average follow-up 104 months).
- Three patients achieved excellent thumb opposition (Kapandji score 5); one achieved functional opposition (Kapandji score 3).
- No significant complications or morbidities were reported in the donor feet.
Conclusions:
- Toe-to-thumb transfer is a viable and effective reconstructive procedure for pediatric thumb loss due to severe burns.
- This technique restores crucial hand functions like sensation, pinch, grasp, and opposition with minimal donor site morbidity.
- Toe-to-thumb transfers should be considered a standard of care for thumb reconstruction in pediatric burn patients.
Abstract:
Children are one of the most vulnerable populations to burns, and hands are frequently burned anatomical structures. Restoring function in a severely burned pediatric hand is challenging. We present our experience with pediatric toe-to-thumb transfers for burn reconstruction. A retrospective review was conducted of all pediatric toe-to-thumb transfer patients between 2009 and 2014. Children younger than the age of 18 who underwent secondary reconstruction after electrical or thermal burn injuries with at least a 5-year follow-up were included. Functional outcomes were measured with the modified Kapandji score. Complications of the reconstructed hand as well as the donor foot were recorded. Four children with 10 toe-to-hand transfers (four great toes, two second toes, and two combined second-third toes) met the inclusion criteria. The average follow-up length was 104 months (range 60-144 months). Two children sustained thermal burn injuries and two sustained electrical burn injuries. Three children achieved opposition of the reconstructed toe-to-thumb transfer to the small finger (Kapandji score 5), and one child achieved opposition of the reconstructed toe-to-thumb transfer to the proximal phalanx of the middle finger, the only remaining finger (Kapandji score 3). No donor foot morbidities were noted postoperatively. Toe-to-thumb transfers should be considered the standard of care for thumb reconstruction in children with severe burn injuries of their hands to provide restoration of sensation, pinch, grasp, and opposition with minimal morbidity of the donor foot.
