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[Free toe transplantation in congenital hand defects]
U Buck-Gramcko1, D Buck-Gramcko
1Abteilung für Handchirurgie und Plastische Chirurgie, Berufsgenossenschaftlichen Unfallkrankenhaus Hamburg.
Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|July 1, 1995
Summary
Free toe transplantation effectively restored hand function in children with congenital malformations, particularly symbrachydactylia. Successful surgeries yielded significant functional improvements, especially in monodactylous cases.
Area of Science:
- Hand Surgery
- Pediatric Orthopedics
- Congenital Malformations
Background:
- Congenital hand malformations significantly impact a child's quality of life.
- Severe symbrachydactylia often requires complex reconstructive procedures.
- Previous prosthetic options had limitations in restoring full hand function.
Purpose of the Study:
- To evaluate the efficacy of free toe transplantation in pediatric patients with congenital hand malformations.
- To assess functional outcomes and complication rates associated with toe-to-hand transfers.
- To determine the indications and contraindications for this surgical procedure.
Main Methods:
- Retrospective review of 30 free toe transplantations performed between 1983 and 1990.
- Focus on patients with symbrachydactylia (monodactylous and peromelic forms).
- Surgical techniques included toe transplantation and lengthening of the radial ray when necessary.
Main Results:
- 25 out of 30 (83.3%) toe transplantations were successful.
- Complications included one total necrosis and four partial necroses of the transplanted toe.
- All 15 patients with monodactylous symbrachydactylia achieved good to very good functional results.
- Peromelic form patients gained crucial grip function unattainable with prosthetics.
- Thumb basal joint (carpometacarpal joint) is critical for successful outcomes.
Conclusions:
- Free toe transplantation is a viable and effective treatment for severe congenital hand malformations in children.
- Careful patient selection, particularly regarding the carpometacarpal joint, is essential for optimal functional results.
- Toe transplantation offers superior functional restoration compared to prosthetics in select cases.