Digital Transfer for Hand Reconstruction in Cleft Hand and Foot Differences
Background Digital transfer for hand reconstruction in children with cleft hand and foot differences present unique challenges with anomalous anatomy and rare opportunities to dramatically improve function of one- or two-digit hands.
Methods Medical records were reviewed for patients with cleft hand and foot treated at two pediatric institutions between 1996 and 2018. Hospital records, clinical photographs, radiographs, and alginate molds were available on all patients. Patient characteristics, indications for transfer, associated syndromes, donor and recipient anatomy, and complications were examined.
Results Twenty digital transfers were identified in 16 patients. The mean age at time of transfer was 6 years (range: 3–18 years). Associated syndromes in this study included ectrodactyly ectodermal dysplasia clefting (EEC) syndrome and Goltz's syndrome. Recipient sites included the thumb (n = 17) and index ray (n = 3) in 10 hands with monodactyly, 6 hands with a two-digit ulnar syndactyly, and 3 hands with central deficiency and associated polydactyly or other anomalies. Donor sites included the great toe (n = 7), fifth toe (n = 9), great toe polydactyly (n = 2), thumb polydactyly (n = 1), and second toe (n = 1). All transfers survived. Revisions included tenolysis (n = 2), repeat fixation for nonunion or malunion (n = 2), and fusion for instability (n = 3).
Conclusion Digital transfer in cleft hand and foot patients is a functional endeavor. The transferred digits provide sensation, mobility, and stability for opposition. Technically challenging due to small structures and atypical anatomy, these rare cases represent unique opportunities to improve function and appearance in the pediatric hand. This is a therapeutic study and reflects level of evidence IV.
Eingereicht: 15. Juni 2020
Angenommen: 21. Dezember 2020
17. Februar 2021 (online)
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 O'Brien BM, Black MJ, Morrison WA, MacLeod AM. Microvascular great toe transfer for congenital absence of the thumb. Hand 1978; 10 (02) 113-124
- 2 Rayan GM, Upton J. Congenital Hand Anomalies and Associated Syndromes. Berlin, Germany: Springer-Verlag; 2014
- 3 Flatt AE. Cleft hand and central defects. In: The Care of Congenital Hand Anomalies. Quality Medical Publishers; 1977: 265-285
- 4 Buck-Gramcko D. Cleft hands: classification and treatment. Hand Clin 1985; 1 (03) 467-473
- 5 May Jr. JW, Smith RJ, Peimer CA. Toe-to-hand free tissue transfer for thumb construction with multiple digit aplasia. Plast Reconstr Surg 1981; 67 (02) 205-213
- 6 Manske PR, Halikis MN. Surgical classification of central deficiency according to the thumb web. J Hand Surg Am 1995; 20 (04) 687-697
- 7 Upton J. Simplicity and treatment of the typical cleft hand. Handchir Mikrochir Plast Chir 2004; 36 (2,3): 152-160
- 8 Upton J, Taghinia AH. Correction of the typical cleft hand. J Hand Surg Am 2010; 35 (03) 480-485
- 9 Chang J, Jones NF. Simultaneous toe-to-hand transfer and lower extremity amputations for severe upper and lower limb defects: the use of spare parts. J Hand Surg [Br] 2002; 27 (03) 219-223
- 10 Jones NF, Hansen SL, Bates SJ. Toe-to-hand transfers for congenital anomalies of the hand. Hand Clin 2007; 23 (01) 129-136
- 11 Kay SP, Wiberg M. Toe to hand transfer in children. Part 1: technical aspects. J Hand Surg [Br] 1996; 21 (06) 723-734
- 12 Kay SP, Wiberg M, Bellew M, Webb F. Toe to hand transfer in children. Part 2: Functional and psychological aspects. J Hand Surg [Br] 1996; 21 (06) 735-745
- 13 Vilkki SK. Advances in microsurgical reconstruction of the congenitally adactylous hand. Clin Orthop Relat Res 1995; (314) 45-58
- 14 Falliner AA. Analysis of anatomic variations in cleft hands. J Hand Surg Am 2004; 29 (06) 994-1001
- 15 Richardson PWF, Johnstone BR, Coombs CJ. Toe-to-hand transfer in symbrachydactyly. Hand Surg 2004; 9 (01) 11-18
- 16 Kaplan JD, Jones NF. Outcome measures of microsurgical toe transfers for reconstruction of congenital and traumatic hand anomalies. J Pediatr Orthop 2014; 34 (03) 362-368
- 17 Nikkhah D, Martin N, Pickford M. Paediatric toe-to-hand transfer: an assessment of outcomes from a single unit. J Hand Surg Eur Vol 2016; 41 (03) 281-294
- 18 Jones NF, Kaplan J. Indications for microsurgical reconstruction of congenital hand anomalies by toe-to-hand transfers. Hand (N Y) 2013; 8 (04) 367-374