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A. W. Morsi - One of the best experts on this subject based on the ideXlab platform.
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non vascularized free Toe Phalanx transfers in congenital hand deformities the great ormond street experience
Journal of Hand Surgery (European Volume), 2003Co-Authors: A. V. Cavallo, Paul Julian Smith, S. Morley, A. W. MorsiAbstract:Many options of varying complexity are available for the management of congenital short digits resulting from aphalangia in symbrachydactyly and constriction ring syndrome. We have used non-vascularized free Toe Phalanx transfers for these children when a vascularized Toe transfer has been contraindicated. We describe our technique and experience with 22 children who underwent a total of 64 transfers of the proximal (35) or middle (29) Toe phalanges (average 3 per child). The mean age at initial surgery was 15 months, and the mean follow-up was 5 years. Duration of time until epiphyseal closure could not be determined accurately, but total digital elongation averaged 6 mm. Complications of this technique include joint instability, premature epiphyseal closure and, in one patient, infection and graft loss. Donor site deformity was determined according to measured growth deficit and Toe function. This technique is a simple option for digital elongation and, if performed in the appropriate age group in short fingered and monodactylous subtypes of symbrachydactyly, has the potential to allow growth and function with minimal donor site deficit.
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Non-vascularized free Toe Phalanx transfers in congenital hand deformities – the great ormond street experience
Journal of hand surgery (Edinburgh Scotland), 2003Co-Authors: A. V. Cavallo, Paul Julian Smith, S. Morley, A. W. MorsiAbstract:Many options of varying complexity are available for the management of congenital short digits resulting from aphalangia in symbrachydactyly and constriction ring syndrome. We have used non-vascularized free Toe Phalanx transfers for these children when a vascularized Toe transfer has been contraindicated. We describe our technique and experience with 22 children who underwent a total of 64 transfers of the proximal (35) or middle (29) Toe phalanges (average 3 per child). The mean age at initial surgery was 15 months, and the mean follow-up was 5 years. Duration of time until epiphyseal closure could not be determined accurately, but total digital elongation averaged 6 mm. Complications of this technique include joint instability, premature epiphyseal closure and, in one patient, infection and graft loss. Donor site deformity was determined according to measured growth deficit and Toe function. This technique is a simple option for digital elongation and, if performed in the appropriate age group in short fingered and monodactylous subtypes of symbrachydactyly, has the potential to allow growth and function with minimal donor site deficit.
A. V. Cavallo - One of the best experts on this subject based on the ideXlab platform.
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non vascularized free Toe Phalanx transfers in congenital hand deformities the great ormond street experience
Journal of Hand Surgery (European Volume), 2003Co-Authors: A. V. Cavallo, Paul Julian Smith, S. Morley, A. W. MorsiAbstract:Many options of varying complexity are available for the management of congenital short digits resulting from aphalangia in symbrachydactyly and constriction ring syndrome. We have used non-vascularized free Toe Phalanx transfers for these children when a vascularized Toe transfer has been contraindicated. We describe our technique and experience with 22 children who underwent a total of 64 transfers of the proximal (35) or middle (29) Toe phalanges (average 3 per child). The mean age at initial surgery was 15 months, and the mean follow-up was 5 years. Duration of time until epiphyseal closure could not be determined accurately, but total digital elongation averaged 6 mm. Complications of this technique include joint instability, premature epiphyseal closure and, in one patient, infection and graft loss. Donor site deformity was determined according to measured growth deficit and Toe function. This technique is a simple option for digital elongation and, if performed in the appropriate age group in short fingered and monodactylous subtypes of symbrachydactyly, has the potential to allow growth and function with minimal donor site deficit.
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Non-vascularized free Toe Phalanx transfers in congenital hand deformities – the great ormond street experience
Journal of hand surgery (Edinburgh Scotland), 2003Co-Authors: A. V. Cavallo, Paul Julian Smith, S. Morley, A. W. MorsiAbstract:Many options of varying complexity are available for the management of congenital short digits resulting from aphalangia in symbrachydactyly and constriction ring syndrome. We have used non-vascularized free Toe Phalanx transfers for these children when a vascularized Toe transfer has been contraindicated. We describe our technique and experience with 22 children who underwent a total of 64 transfers of the proximal (35) or middle (29) Toe phalanges (average 3 per child). The mean age at initial surgery was 15 months, and the mean follow-up was 5 years. Duration of time until epiphyseal closure could not be determined accurately, but total digital elongation averaged 6 mm. Complications of this technique include joint instability, premature epiphyseal closure and, in one patient, infection and graft loss. Donor site deformity was determined according to measured growth deficit and Toe function. This technique is a simple option for digital elongation and, if performed in the appropriate age group in short fingered and monodactylous subtypes of symbrachydactyly, has the potential to allow growth and function with minimal donor site deficit.
William H. Seitz - One of the best experts on this subject based on the ideXlab platform.
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Long-Term Donor-Site Morbidity After Free, Nonvascularized Toe Phalanx Transfer for Congenital Differences of the Hand.
The Journal of hand surgery, 2019Co-Authors: Noah M. Raizman, Jonas A. Reid, Adam F. Meisel, William H. SeitzAbstract:Purpose Toe Phalanx transplantation is a well-established technique for addressing bony deficiency in the reconstruction of hypoplastic digits in patients with congenital differences of the hand. Prior studies have commented on varying degrees of donor-site morbidity, although assessment of morbidity with validated outcome scores is lacking. This study seeks to evaluate donor-site morbidity after Toe Phalanx harvest using validated outcome measures. Methods We identified all children who underwent free, nonvascularized Toe Phalanx transfer to the hand at our institution from 2001 to 2011. We administered the Oxford Ankle Foot Questionnaire for Children (OXAFQ-C) and the Foot and Ankle Ability Measure (FAAM) to all patients, scaling results according to published scoring instructions. Results Thirty-six patients with 83 Toe Phalanx transfers were able to be contacted, with a mean follow-up of 5.3 years (range, 18 months–11.2 years). The results of the OXAFQ-C showed mean scores of 99.96% (Physical), 100% (School and Play), and 96.01% (Emotional). The FAAM mean scores were 99.08% (Sports) and 99.17% (Activities of Daily Living). There were no lower extremity complications during the study period. Conclusions In contrast to varying degrees of donor-site morbidity reported in the current literature, this study demonstrates that Toe Phalanx harvest causes almost no measurable lower extremity morbidity or dysfunction over the mid- to long-term. Type of study/level of evidence Therapeutic IV.
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Nonvascularized Toe phalangeal transfer and distraction lengthening for symbrachydactyly.
The Journal of hand surgery, 2010Co-Authors: Ryan W. Patterson, William H. SeitzAbstract:Symbrachydactyly describes a spectrum of congenital hand differences consisting of digital loss resulting in fused short fingers. As the principles for distraction lengthening have evolved, the technique of nonvascularized Toe phalangeal transfer to the hand with shortened digits has provided patients with improved outcomes. Nonvascularized Toe Phalanx to hand transplant with distraction lengthening restores functional length to a skeletally deficient, poorly functioning hand while maintaining an overlying layer of vascular and sensate tissue. The primary goal is improvement of digital length to enhance mechanical advantage and prehension. We describe the technique of nonvascularized Toe phalangeal transfer and distraction lengthening for symbrachydactyly, including the following steps: nonvascularized proximal Toe Phalanx harvest, Toe Phalanx transfer to hand, pin placement, osteotomy, and closure.
Hidehiko Kawabata - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Blauth Type IIIB Thumb Hypoplasia Using a Nonvascularized Toe Phalanx.
The Journal of hand surgery, 2020Co-Authors: Hidehiko Kawabata, Daisuke Tamura, Charles A. GoldfarbAbstract:Purpose The purpose of this study was to evaluate surgical outcomes of thumb preservation surgery for Blauth type IIIB hypoplastic thumbs using a nonvascularized Toe Phalanx to reconstruct the carpometacarpal joint. Methods We reviewed the records of 12 patients with Blauth type IIIB thumb hypoplasia who underwent nonvascularized Toe proximal Phalanx transfer from the fourth Toe. Stability and mobility of the thumb, lateral pinch power, and the percentage of the thumb length relative to the index finger proximal Phalanx were evaluated. Outcomes were also assessed with the Functional Dexterity Test, a visual analog scale for daily use of the operated thumb, and for overall functional and appearance satisfaction of the parents. Results Age at operation ranged from 0.9 to 11 years (mean, 3.0 years; median, 1.5 years). The mean follow-up period was 7.6 years (minimum, 3 years). Secondary reconstruction was planned in all 12 patients, but 2 families did not desire a second surgery. Secondary reconstruction consisted of tendon transfer for opposition, adduction, and/or extension of the reconstructed thumb and/or realignment surgery of the thumb axis by arthrodesis or corrective osteotomy. Eleven patients had good carpometacarpal joint stability. Thumb opposition was possible to the little finger in 7, to the middle finger in 3, and not possible in 2 patients. The mean lateral pinch strength was 18% of the contralateral normal side. The relative length of the thumb was 57% of the index finger. Time in seconds to complete Functional Dexterity Test was 83 seconds in the affected side and 38 seconds for the contralateral side. The visual analog scale suggested parental satisfaction for both the appearance and the function. The parents felt that their child used the reconstructed thumb more frequently when manipulating large objects than when manipulating small objects. Conclusions Nonvascularized Toe Phalanx transfer is a useful procedure to preserve the thumb in Blauth type IIIB thumb hypoplasia. It provides a mobile, stable thumb that is functionally useful for the child and satisfying for the family. Type of study/level of evidence Therapeutic IV.
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Five- and 10-Year Follow-Up of Nonvascularized Toe Phalanx Transfers.
The Journal of hand surgery, 2017Co-Authors: Hidehiko Kawabata, Daisuke TamuraAbstract:Purpose The purpose of this study was to evaluate long-term outcomes of nonvascularized Toe Phalanx transfer. Methods We retrospectively reviewed 54 nonvascularized Toe Phalanx transfers in 29 children with symbrachydactyly. Forty-seven transfers in 24 children were evaluated at 5-year follow-up and 27 transfers in 14 children were evaluated at 10-year follow-up. We recorded the incidence of the early physeal closure and the length of the transferred Toe Phalanx on plain radiographs at 5- and 10-year follow-up. Growth rate in the first 5 years and the following 5 years were calculated. Function of the metacarpophalangeal joint (motion, stability, and alignment) was also evaluated. Results The mean age at surgery was 1.5 years. Seven Toe phalanges were trimmed because the skin pocket was tight. Five transfers required revision surgery for partial necrosis of the skin pocket. At 5-year follow-up, the physis was closed in 23%, and at 10 years, 78% of physes were closed. The Phalanx length was 87% of expected at 5-year follow-up and 71% at 10-year follow-up. Growth rate was 0.83 mm/y in the first 5 years and 0.22 mm/y in the following 5 years. Active motion was rated as good in 24, fair in 7, and poor in 16. Stability and alignment were rated as good in 37 and 33, fair in 8 and 5, and poor in 2 and 9, respectively. Conclusions Nonvascularized Toe Phalanx transfer offered a relatively simple method to lengthen short digits and to provide satisfactory function. The transferred Toe phalanges grew at a near-normal rate in the first 5 years, but the growth rate decreased between 5 and 10 years. Type of study/level of evidence Therapeutic IV.
Daisuke Tamura - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Blauth Type IIIB Thumb Hypoplasia Using a Nonvascularized Toe Phalanx.
The Journal of hand surgery, 2020Co-Authors: Hidehiko Kawabata, Daisuke Tamura, Charles A. GoldfarbAbstract:Purpose The purpose of this study was to evaluate surgical outcomes of thumb preservation surgery for Blauth type IIIB hypoplastic thumbs using a nonvascularized Toe Phalanx to reconstruct the carpometacarpal joint. Methods We reviewed the records of 12 patients with Blauth type IIIB thumb hypoplasia who underwent nonvascularized Toe proximal Phalanx transfer from the fourth Toe. Stability and mobility of the thumb, lateral pinch power, and the percentage of the thumb length relative to the index finger proximal Phalanx were evaluated. Outcomes were also assessed with the Functional Dexterity Test, a visual analog scale for daily use of the operated thumb, and for overall functional and appearance satisfaction of the parents. Results Age at operation ranged from 0.9 to 11 years (mean, 3.0 years; median, 1.5 years). The mean follow-up period was 7.6 years (minimum, 3 years). Secondary reconstruction was planned in all 12 patients, but 2 families did not desire a second surgery. Secondary reconstruction consisted of tendon transfer for opposition, adduction, and/or extension of the reconstructed thumb and/or realignment surgery of the thumb axis by arthrodesis or corrective osteotomy. Eleven patients had good carpometacarpal joint stability. Thumb opposition was possible to the little finger in 7, to the middle finger in 3, and not possible in 2 patients. The mean lateral pinch strength was 18% of the contralateral normal side. The relative length of the thumb was 57% of the index finger. Time in seconds to complete Functional Dexterity Test was 83 seconds in the affected side and 38 seconds for the contralateral side. The visual analog scale suggested parental satisfaction for both the appearance and the function. The parents felt that their child used the reconstructed thumb more frequently when manipulating large objects than when manipulating small objects. Conclusions Nonvascularized Toe Phalanx transfer is a useful procedure to preserve the thumb in Blauth type IIIB thumb hypoplasia. It provides a mobile, stable thumb that is functionally useful for the child and satisfying for the family. Type of study/level of evidence Therapeutic IV.
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Five- and 10-Year Follow-Up of Nonvascularized Toe Phalanx Transfers.
The Journal of hand surgery, 2017Co-Authors: Hidehiko Kawabata, Daisuke TamuraAbstract:Purpose The purpose of this study was to evaluate long-term outcomes of nonvascularized Toe Phalanx transfer. Methods We retrospectively reviewed 54 nonvascularized Toe Phalanx transfers in 29 children with symbrachydactyly. Forty-seven transfers in 24 children were evaluated at 5-year follow-up and 27 transfers in 14 children were evaluated at 10-year follow-up. We recorded the incidence of the early physeal closure and the length of the transferred Toe Phalanx on plain radiographs at 5- and 10-year follow-up. Growth rate in the first 5 years and the following 5 years were calculated. Function of the metacarpophalangeal joint (motion, stability, and alignment) was also evaluated. Results The mean age at surgery was 1.5 years. Seven Toe phalanges were trimmed because the skin pocket was tight. Five transfers required revision surgery for partial necrosis of the skin pocket. At 5-year follow-up, the physis was closed in 23%, and at 10 years, 78% of physes were closed. The Phalanx length was 87% of expected at 5-year follow-up and 71% at 10-year follow-up. Growth rate was 0.83 mm/y in the first 5 years and 0.22 mm/y in the following 5 years. Active motion was rated as good in 24, fair in 7, and poor in 16. Stability and alignment were rated as good in 37 and 33, fair in 8 and 5, and poor in 2 and 9, respectively. Conclusions Nonvascularized Toe Phalanx transfer offered a relatively simple method to lengthen short digits and to provide satisfactory function. The transferred Toe phalanges grew at a near-normal rate in the first 5 years, but the growth rate decreased between 5 and 10 years. Type of study/level of evidence Therapeutic IV.
