Vascularized transfer of two coherent toe joints in simultaneously reconstructing MCP and PIP of a mutilated finger

Reconstruction of mutilating hand injuries by microsurgical free tissue transfers from the foot

INTRODUCTION

The aim of this study is to present various hand reconstruction methods and provide technical notes regarding the treatment of mutilating hand injuries using free-tissue transfers from the foot and to investigate whether these transfers provide patients with a usable hand or not.

PATIENTS AND METHODS

Ninety patients with mutilating hand injuries were included in the study. A total of 101 procedures were performed. Patients were contacted by phone to evaluate their working status and to record any complaints regarding their donor sites. The Quickdash questionnaire was conducted for the 53 patients who could be reached. Operative techniques, secondary procedures, finger survival, and physiotherapy data were noted retrospectively.

RESULTS

In 36 patients, a trimmed great toe was transferred to the thumb. Second toe-to-thumb transfers were performed in 8 patients, and second toe-to-finger transfers were performed in 10 patients. In 13 patients, 2 toes from one side were transferred, and in 6 patients, 3 toes were transferred to the hand. Bilateral toe transfers were performed in 9 patients. Eight patients underwent joint transfers, of which 2 involved joint transfers from both feet. The overall finger survival rate for the transfer procedures was 95.04%. The average Quickdash score of the patients who could be reached (n = 53) was 27.49, with 62.3% of the patients being able to use their hands in their previous jobs, and 26.4% needing to change their jobs because of their hand injuries. 41.5% of the patients had no donor site complaints. 47.2% had mild complaints, and 11.3% had major donor site complaints.

CONCLUSION

Multiple-toe transfer techniques along with flap coverage options should be considered, and delicate planning is mandatory to achieve at least a basic or acceptable hand. Three toes, including the great toe, can be transferred in a single operation by dissecting both the dorsal and plantar arterial systems. Crush injuries of the dorsal side of the hand may be reconstructed using combined transfers of bones, joints, extensor tendons, and skin. In our series, 88.7% of patients with mutilating hand injuries were able to return to work after we performed tissue transfers from the foot.

Arthroplasty for Treating Traumatic Metacarpophalangeal Joint Defects: A Retrospective Study Over Three Years

Background

Bone loss at the metacarpophalangeal joint (MCP) after trauma is difficult to treat.

Objective

We aimed to investigate the effectiveness of Swanson's arthroplasty and the reason for implant fracture.

Methods

We retrospectively analyzed the data of 175 patients who underwent emergency MCP arthroplasty between 2013 and 2016. Some patients used a orthosis to limit the radioulnar movement of the metacarpal joint for eight weeks after surgery (Group A), while the other patients underwent only hand rehabilitation after surgery (Group B). The basic information and perioperative data of the patients were compared. The patients were followed up clinically for an average of 65±19 months. Postoperative and follow-up complications and functional parameters were recorded and compared. Stress model of implant fracture had been analyzed in order to mark the frequent area.

Results

A total of 162 patients were followed up, 4 of whom were lost to follow-up completely and 9 of whom were followed up by telephone only. There were 11 and 26 implant fractures in groups A and B, respectively (P=0.019), and the degrees of radioulnar movement were 2±1° and 7±4°, respectively (P<0.01). The disabilities of the arm, shoulder, and hand (DASH) score and MCP joint range of motion (ROM) did not significantly differ.

Conclusion

The effect of Swanson’s arthroplasty for bone loss at MCP joint is useful. The radioulnar stress may be the reason for implant fracture. Joint orthosis can reduce the incidence of implant fractures.