J Reconstr Microsurg 2018; 34(09): 692-700
DOI: 10.1055/s-0038-1642024
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Investigating Patients' Perception of Microvascular Free Toe Flap for Reconstruction of Amputated Thumbs: A Guide for Surgeons during Informed Consent

Johnny Ionut Efanov
1   Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
,
Christopher Wong
1   Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
,
Clarence Guilbault
1   Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
,
Joseph Bou-Merhi
1   Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
,
Patrick G. Harris
1   Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
,
Ali Izadpanah
1   Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
,
Michel Alain Danino
1   Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

12 November 2017

06 March 2018

Publication Date:
24 April 2018 (online)

Abstract

Background After thumb amputations, restoration of function and aesthetic can be accomplished with microvascular free toe flaps. However, many patients in clinical practice do not choose this reconstruction despite positive reported outcomes. This study aims to determine patients' perceptions with respect to free toe flaps to improve areas of informed consent.

Methods A retrospective survey was administered to patients with thumb amputations. Participants were required to complete a questionnaire about patient demographics, the Brief Michigan Hand Questionnaire (bMHQ), the standard gamble/time trade-off questionnaires for utility scores, and a questionnaire investigating potential reasons for electing not to undergo a free toe transfer.

Results Thirty patients were enrolled in the study wherein 53% underwent a replantation procedure, 27% a revision amputation, and 20% a delayed reconstruction. Mean normalized score on the bMHQ was recorded as 63.54. Utility questionnaires yielded mean measures of 0.8967 and 0.86 on the standard gamble and time trade-off, respectively. From 14 elements, a majority (87%) stated flap failure as a major source of concern, followed by lack of understanding of risks and benefits (80%) and prolonged hospital stay (53%). Cultural/religious beliefs, aesthetic appearance of the foot, and concerns about footwear were not reported as important reasons in 90, 80, and 79% of patients, respectively.

Conclusion A better understanding of patients' attitudes and beliefs with respect to free toe flaps will allow surgeons to better address their concerns during informed consent. This study emphasizes the importance to discuss about failure rates, risks, and benefits of the operation and prolonged hospital stay.

 
  • References

  • 1 Shale CM, Tidwell III JE, Mulligan RP, Jupiter DC, Mahabir RC. A nationwide review of the treatment patterns of traumatic thumb amputations. Ann Plast Surg 2013; 70 (06) 647-651
  • 2 Cobbett JR. Free digital transfer. Report of a case of transfer of a great toe to replace an amputated thumb. J Bone Joint Surg Br 1969; 51 (04) 677-679
  • 3 Foucher G, Medina J, Navarro R, Nagel D. Toe transfer in congenital hand malformations. J Reconstr Microsurg 2001; 17 (01) 1-7
  • 4 Govila A. Improvisation in wrap-around toe-to-thumb transfer. Acta Chir Plast 1993; 35 (3–4): 101-110
  • 5 Cheng G, Fang G, Hou S. , et al. Aesthetic reconstruction of thumb or finger partial defect with trimmed toe-flap transfer. Microsurgery 2007; 27 (02) 74-83
  • 6 Buncke HJ, Rose EH. Free toe-to-fingertip neurovascular flaps. Plast Reconstr Surg 1979; 63 (05) 607-612
  • 7 Foucher G, Merle M, Maneaud M, Michon J. Microsurgical free partial toe transfer in hand reconstruction: a report of 12 cases. Plast Reconstr Surg 1980; 65 (05) 616-627
  • 8 Lee DC, Kim JS, Ki SH, Roh SY, Yang JW, Chung KC. Partial second toe pulp free flap for fingertip reconstruction. Plast Reconstr Surg 2008; 121 (03) 899-907
  • 9 Frykman GK, O'Brien BM, Morrison WA, MacLeod AM. Functional evaluation of the hand and foot after one-stage toe-to-hand transfer. J Hand Surg Am 1986; 11 (01) 9-17
  • 10 Wei FC, Carver N, Lee YH, Chuang DC, Cheng SL. Sensory recovery and Meissner corpuscle number after toe-to-hand transplantation. Plast Reconstr Surg 2000; 105 (07) 2405-2411
  • 11 Lin PY, Sebastin SJ, Ono S, Bellfi LT, Chang KW, Chung KC. A systematic review of outcomes of toe-to-thumb transfers for isolated traumatic thumb amputation. Hand (NY) 2011; 6 (03) 235-243
  • 12 Kim HD, Hwang SM, Lim KR, Jung YH, Ahn SM, Song JK. Toe tissue transfer for reconstruction of damaged digits due to electrical burns. Arch Plast Surg 2012; 39 (02) 138-142
  • 13 Kim HS, Lee DC, Kim JS. , et al. Donor-site morbidity after partial second toe pulp free flap for fingertip reconstruction. Arch Plast Surg 2016; 43 (01) 66-70
  • 14 Waljee JF, Kim HM, Burns PB, Chung KC. Development of a brief, 12-item version of the Michigan Hand Questionnaire. Plast Reconstr Surg 2011; 128 (01) 208-220
  • 15 Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ 1986; 5 (01) 1-30
  • 16 Stevens KJ, McCabe CJ, Brazier JE. Mapping between Visual Analogue Scale and Standard Gamble data; results from the UK Health Utilities Index 2 valuation survey. Health Econ 2006; 15 (05) 527-533
  • 17 Li YK, Alolabi N, Kaur MN, Thoma A. A systematic review of utilities in hand surgery literature. J Hand Surg Am 2015; 40 (05) 997-1005
  • 18 Alolabi N, Chuback J, Grad S, Thoma A. The utility of hand transplantation in hand amputee patients. J Hand Surg Am 2015; 40 (01) 8-14
  • 19 Chung KC, Walters MR, Greenfield ML, Chernew ME. Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis. Plast Reconstr Surg 1998; 102 (04) 1089-1099
  • 20 Pet MA, Ko JH, Vedder NB. Reconstruction of the traumatized thumb. Plast Reconstr Surg 2014; 134 (06) 1235-1245
  • 21 Lipton HA, May Jr JW, Simon SR. Preoperative and postoperative gait analyses of patients undergoing great toe-to-thumb transfer. J Hand Surg Am 1987; 12 (01) 66-69
  • 22 Chung KC, Wei FC. An outcome study of thumb reconstruction using microvascular toe transfer. J Hand Surg Am 2000; 25 (04) 651-658
  • 23 Morrison WA, O'Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg Am 1980; 5 (06) 575-583
  • 24 Vergara-Amador E. Second toe-to-hand transplantation: a surgical option for hand amputations. Colomb Med (Cali) 2015; 46 (02) 71-74
  • 25 Venkatramani H, Bhardwaj P, Sierakowski A, Sabapathy SR. Functional outcomes of post-traumatic metacarpal hand reconstruction with free toe-to-hand transfer. Indian J Plast Surg 2016; 49 (01) 16-25
  • 26 Lam WL, Wei FC. Toe-to-hand transplantation. Clin Plast Surg 2011; 38 (04) 551-559
  • 27 Lloyd A, Hayes P, Bell PR, Naylor AR. The role of risk and benefit perception in informed consent for surgery. Med Decis Making 2001; 21 (02) 141-149
  • 28 Shekelle PG, Wachter RM, Pronovost PJ. , et al. Making health care safer II: an updated critical analysis of the evidence for patient safety practices. Comparative Effectiveness Review No. 211. (Prepared by the Southern California-RAND Evidence-based Practice Center under Contract No. 290–2007–10062-I.) AHRQ Publication No. 13–E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; March 2013. Available at: www.ahrq.gov/research/findings/evidence-based-reports/ptsafetyuptp.html
  • 29 Shauver MJ, Nishizuka T, Hirata H, Chung KC. Traumatic finger amputation treatment preference among hand surgeons in the United States and Japan. Plast Reconstr Surg 2016; 137 (04) 1193-1202
  • 30 Chung KC, Oda T, Saddawi-Konefka D, Shauver MJ. An economic analysis of hand transplantation in the United States. Plast Reconstr Surg 2010; 125 (02) 589-598