Toe-to-hand Transfers In Children - Indications And Results
Neil F. Jones, MD, Katherine Au, MD.
UCLA, Los Angeles, CA, USA.
PURPOSE: Hand surgeons unfortunately remain reticent to consider microsurgical toe-to-hand transfers for reconstruction of missing digits in children. Specific indications continue to evolve and increasing success should result in more universal acceptance of these techniques in children over the conventional techniques of non-vascularized toe phalangeal bone grafting and distraction lengthening.METHODS: 103 hands with missing digits in 98 children aged between 2 and 14 years underwent microsurgical reconstruction with toe-to-hand transfers. 25 hands were missing a thumb; 20 hands were missing a thumb and multiple fingers; 41 hands were missing all four fingers but with a normal thumb; and 17 hands were missing all five digits. 62 thumbs and 65 fingers were reconstructed. 5 children had bilateral hand deformities. RESULTS: 127 toe transfers were performed, 100 second toes, 20 great toes, 3 combined second-third toes and one third toe. 10 toe transfers required postoperative exploration of the anastomoses, 8 were salvaged for a success rate of 98%. All children developed pinch and grasp function and regained sensation in the transferred toe/s. Serial radiographs confirmed growth of the toe transfer. There were no long term problems with healing of the donor foot/feet or ambulation. Parents reported that the function of their child's hand had improved following the toe transfer according to PODCI (Pediatric Outcomes Data Collection Instrument) questionnaires.CONCLUSIONS: Despite the technical complexity, the potential risk of loss of the toe and very specific indications, microsurgical toe-to-hand transfers should be considered the gold standard for reconstruction of missing digits in children.
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