Metacarpal Hand Reconstruction by Combined Second and Third Toe Transfer (original) (raw)
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CASE REPORT Type II Metacarpal Hands: Reconstruction Planning Revisited
Eplasty, 2010
Successful reconstruction of the metacarpal hand requires thorough evaluation and careful surgical planning. Effective transplantation involves 3 main considerations: residual hand function, functional needs and desires of the patient, and optimal surgical management to maximize outcome and minimize patient morbidity. The following is a clinical example of the metacarpal hand in which the patient underwent initial reconstruction at an outside hospital and was referred to our institution. This demonstrates how the initial planning and surgical management could have been further optimized to minimize functional deficits and donor-site morbidities as well as reduce the number of subsequent revisional surgeries and rehabilitation time. Several important points in metacarpal hand reconstruction are described given specific level of amputation and residual function after the injury-the timing and sequence of operative strategy depending on the type of injury, the selection of donor-site d...
2020
BACKGROUND Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor aesthetics. Great toe transplantation achieves better aesthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and aesthetic satisfaction in thumb reconstruction.METHODS We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a co...
The Journal of Hand Surgery, 2018
Thumb amputation at the carpometacarpal level is very incapacitating. Pollicization may be considered. We describe an alternate technique for thumb reconstruction at the level of the metacarpal base using a trimmed great toe along with a vascularized second metatarsophalangeal joint, including the second metatarsal, all supplied on a single vascular pedicle. Two patients who had a combined soft tissue defect and amputation of the thumb close to the carpometacarpal joint were reconstructed with this method. A transposition of the second toe was performed on top of the remaining proximal phalanx of the great toe to decrease donor site morbidity. This technique provides adequate length to the thumb without compromising another finger by creating a new thumb using a double microsurgical toe transfer on a single vascular pedicle. We minimize donor site morbidity by transposing the second toe onto the great toe.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2015
five adults who had suffered bilateral traumatic below-30 elbow amputations, received bilateral hand-forearm allografts realized by the Lyon team. We 31 report the functional benefits achieved over a mean follow-up period of 7.6 years (range 4-13 32 years), up to December 31 st , 2013. Clinical measurement is hampered by the lack of specific 33 validated assessment tools, obliging us to use non-specific standardized evaluation means. Our 34 assessment shows that the restoration of motion, strength, and sensibility are fair. Functional 35 results (Carroll upper extremity function test, 400-point test, Activities of daily living) are good, 36 as well as quality of life evaluation (RAND-36). Subjective and overall results explored with 37 questionnaires -Disabilities of the Arm Shoulder and Hand (DASH), Hand Transplantation Score 38
Functional outcomes of post-traumatic metacarpal hand reconstruction with free toe-to-hand transfer
Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India
We present the functional outcomes of microvascular toe transfer to reconstruct the post-traumatic metacarpal hand deformity. Twelve toe transfers were successfully carried out in 11 patients. In each patient, the level of injury was classified according to the Wei classification system. Functional outcome was measured in seven patients using the Tamai score. Additional objective tests of function were carried out in three patients, including the Jebsen test, grip strength, pinch strength, web opening, static and moving two-point discrimination and Semmes-Weinstein monofilament testing. The average Tamai score was 69 (range 60-83.5). Six patients achieved 'good' outcomes and one patient, with a double toe transfer, an 'excellent' outcome. The average follow-up time was 43 months (range 10-148 months). This study shows how even a single toe transfer can restore useful function to a hand that has otherwise lost all prehensile ability.
2013
Amputation at the proximal phalanx or at the metacarpophalangeal joint can be treated by pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, or distraction lengthening. The best technique to use to treat these cases depends on the place of amputation and the patient's age, sex, occupation and functional demands. In the past 6 years, we treated 4 patients by lengthening the thumb metacarpal ray and adding a mini wraparound flap from the great toe. All the subjects were female with an average age of 22 years. All 4 patients had sustained traumatic amputations: 2 at the metacarpophalangeal joint and 2 at the base of the proximal phalanx. Distraction was completed approximately 65 days after osteotomy, obtaining an average lengthening of 23 mm. To achieve bone consolidation, the lengthener was left in place for 127 days on average. Microsurgical thumb reconstruction was performed around 3 months after consolidation of the osteotomy. There were no failures or cases of postoperative vascular compromise. The average pinch power was 66% of the opposite hand. The static 2-point discrimination of the reconstructed thumb was 8 mm (range, 7-10 mm). All patients reported being satisfied with the treatment, although 1 patient was partially dissatisfied due to the prolonged length of the treatment. Donor site morbidity was minimal. This procedure is mainly chosen by selected patients who refuse standard microsurgical thumb reconstruction because it requires a longer treatment period
Late reconstruction of a traumatized hand with loss of multiple fingers
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2017
Reconstrução tardia na mão traumatizada com perda de múltiplos dedos Mutilating hand injuries are a challenge to both the hand surgeon and the patient. The surgeon must make decisions ranging from the initial debridement to which fingers and joints will be preserved and the appropriate use of the parts to be removed. Late reconstruction constitutes the second part of this difficult task. The difficulty attributed to the characteristics of each lesion, the large number of treatment possibilities, and the different levels of complexity must be adapted to the personal needs and motivation of each patient. This case report describes a late hand reconstruction with index and middle finger loss, using metacarpophalangeal joint transplantation of the index finger to gain the proximal interphalangeal function of the middle finger.
2024
Introduction Hand amputation at the wrist level is severely disabling, especially when bilateral. It is paramount to restore the hand function to the best possible level for the patient’s daily living activities, as well as optimal social and occupational rehabilitation. There are various options for restoration of function after amputation at wrist and distal forearm levels including Krukenberg’s operation, variations of toe transfers, hand allotransplantation, and prosthesis. Krukenberg’s procedure and the reconstruction using toe transfer like Vilkki’s procedure or two-toe transfers, restore only the pinch. Hand allotransplantation, although it gives excellent function, has limitations due to the complications of immunosuppression. Functional hand prosthesis, though superior in cosmetic appearance, have again limitations in function, and the cost is prohibitive for most patients in our country. Materials and Methods We present the unique case of a bilateral hand amputation at the wrist level reconstructed with three toes and free anterolateral thigh (ALT) flap in a single-stage surgery for each hand. In two stages, the patient had six toes transferred to both hands. Result All transferred toes and all three free (two ALT and one thoracodorsal artery perforator) flaps survived completely. Three-finger grip (tripod pinch) was thus restored in each hand. The hook grip was also restored well by the reconstructed two fingers. Within 3 months after surgery, the patient could perform all activities of daily living. He resumed his original job with some modification of his work within 6 months postinjury. Conclusion Hand reconstruction using three toes and a free flap is an excellent option for functional restoration for amputation at the wrist and distal forearm level. It allows an early return to function and good social and professional integration of the patient. This procedure is a potential alternative to expensive prosthesis and allotransplantation for a bilateral hand amputation.
Pincer reconstruction using second toe transplantation
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 1987
Nine patients who had suffered mutilating injuries of the hand with preservation of only one digit and loss of the others at metacarpal level have been treated by transfer of the second toe onto a metacarpal stump to restore pincer grip. The transfers did not all survive but those which did gave useful function.