Composite toe (phalanx and epiphysis) transfers in the reconstruction of the aphalangic hand

Twenty children with ectrodactyly have had 36 digits reconstructed with toe phalanges inserted into the existing soft tissue finger pouches or pouches constructed with local tissue. Care is taken to preserve the periosteum, epiphyseal plate, and collateral ligaments of the transfers. No surgical microvascular anastomoses are performed, and the entire procedure takes less than 30 minutes. Epiphyseal patency rates in children with a mean follow-up of 3.4 years and a median of 4 years are 90% for those operated on at 6 months to 1 1/2 years of age, 67% in those operated on at 1 1/2 to 5 years, and 50% in children operated on at 5 to 13 years of age. Radiographic growth measurements show average growths greater than 90% of the expected growth based on measurements of the contralateral donor phalanx for all transfers with open epiphyses. These reconstructed digits provide fingers that are sensate, capable of pinch and grasp, and able to tolerate heavy use.