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Free Vascularized Joint Transfer from Toes for Finger Reconstruction in a 2-Year-Old Child with Good Functional
1Department of Plastic Surgery, Susrutha Institute of Plastic, Reconstructive, and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India.
Journal of Hand and Microsurgery
|April 6, 2023
Summary
This study details a successful staged surgical reconstruction for a child with severe hand injuries, utilizing toe joint transfers to restore finger function and bone length. The innovative approach achieved excellent functional outcomes a year post-surgery.
Area of Science:
- Orthopedic surgery
- Pediatric reconstructive surgery
- Microsurgery
Background:
- Severe digital trauma in children presents complex reconstructive challenges.
- Loss of bone, joints, and soft tissue requires advanced surgical techniques for salvage.
Observation:
- A 2-year-old male experienced extensive mutilation of the right middle and ring fingers due to a road traffic accident.
- This included loss of phalanges, proximal interphalangeal (PIP) joints, and dorsal soft tissue.
Findings:
- A staged reconstruction involved initial soft tissue repair with a pedicled groin flap.
- Subsequent free transfer of PIP joints from the patient's second toes reconstructed the bone and joints of the injured fingers.
- The salvage procedure resulted in good functional recovery one year after the joint transfer.
Implications:
- This case demonstrates the efficacy of free toe joint transfer in pediatric digital reconstruction.
- Staged reconstructive strategies can successfully salvage severely mangled digits in young children.
- Preserving digital length and function through innovative microsurgical techniques is crucial for long-term hand function.
