Donor Foot Morbidity Following Nonvascularized Toe Phalanx Transfer Utilizing a New Reconstruction Technique

Area of Science:

• Orthopedic surgery
• Pediatric hand surgery
• Congenital hand abnormalities

Background:

• Nonvascularized toe phalanx transfer is a common treatment for hypoplastic digits.
• Donor site morbidity is a significant concern with this procedure.
• A novel reconstruction technique was developed to address donor site issues.

Purpose of the Study:

• To evaluate donor foot morbidity after nonvascularized toe phalanx transfer.
• To assess the efficacy of a new donor site reconstruction technique using iliac osteochondral bone graft with periosteum.

Main Methods:

• Retrospective review of 116 toe phalanx transfers in 69 children (2001-2020).
• Donor feet reconstructed with iliac osteochondral bone graft and periosteum.
• Clinical evaluation of metatarsophalangeal joint motion, stability, and alignment; radiographic assessment of toe length; parental satisfaction surveys.

Main Results:

• 94 feet in 65 patients were analyzed with a mean follow-up of 7.6 years.
• Good metatarsophalangeal joint motion (69%), stability (95%), and alignment (84%) were observed.
• High parental satisfaction reported for both function and appearance, with minimal need for revision surgery.

Conclusions:

• The novel technique using iliac osteochondral bone graft with periosteum for toe phalanx donor site reconstruction yields satisfactory outcomes.
• This method effectively preserves donor foot function and appearance.
• The described technique is a viable option for managing donor site morbidity in toe phalanx transfers.