Onycho-Osteo-Cutaneous Defects of the Thumb Reconstructed by Partial Hallux Transfer

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• 作者：Francisco del Pi帽al ; Eduardo Moraleda ; Guillermo H. de Piero ; Jaime S. Ruas ; Carlos Galindo
• 关键词：Microsurgery ; thumb amputation ; toe-to-hand transfer ; mutilated hand
• 刊名：The Journal of Hand Surgery
• 出版年：January, 2014
• 年：2014
• 卷：39
• 期：1
• 页码：29-36
• 全文大小：3459 K

文摘

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Purpose

To present our experience in distal thumb amputations reconstructed by partial toe to hand transfers with special emphasis on manual workers.

Methods

Twenty-five patients who experienced amputation of the thumb distal to the interphalangeal joint, excluding pure soft tissue losses, were included in the study. All but 2 were manual workers. Twenty were reconstructed within 2 weeks after injury. The other 5 were referred late. In all patients, the ipsilateral hallux was used as donor, based on the proper digital artery (18 cases), the intermetatarsal artery (6 cases), and the dorsalis pedis artery (1聽case).

Results

All transferred flaps survived. At a minimum follow-up of 1 year (range, 1-14 y), active range of motion at the interphalangeal joint was more than 55掳 in 23 patients. Two had an interphalangeal joint arthrodesis, 1 of them before referral. Pinch and grip were similar to聽the contralateral side. Two-point discrimination was normal in the dorsal oblique amputations and 7 to 11 mm in the rest. Patient satisfaction was high from a functional and aesthetic standpoint (9.5 out of 10 on a visual analog scale for both outcomes). All patients returned to work 2 to 4.5 months after the operation. Delayed donor site healing was noticed in 4 cases.

Conclusions

In contrast to classic teaching that recommends stump closure for cases of distal聽thumb amputation, we attained excellent results with partial toe transfer in manual workers. In our experience, the thumb can be restored to nearly normal with an acceptable donor site sequela. The best indication is for cases of dorsal oblique amputations, because thumb sensibility is unaffected, and for amputations where the germinal matrix is preserved, because nail regrowth occurs. Early transfer is strongly recommended.

Type of study/level of evidence

Therapeutic IV.