Subscribe to RSS
Download PDF
DOI: 10.1055/s-0045-1809370
Advancement in Vascularized Toe PIP Joint Transfers: Technical Evolution and Current Practices
Funding None.
Abstract
Vascularized toe proximal interphalangeal joint transfer has evolved as a biological solution for posttraumatic finger joint reconstruction. Extension lag has been recognized as a major challenge since its introduction in the 1980s. A significant advancement came from the 2013 anatomical study that characterized two distinct patterns of toe extensor mechanism: Type 1 (>95%) lacking obvious central slip insertion, and Type 2 (<5%) with clear central slip insertion. This understanding led to customized reconstruction strategies based on both donor toe anatomy and recipient finger condition. Various techniques, including centralization, direct repair, and central slip reconstruction, have been developed. The Te technique was developed to minimize bone manipulation while achieving similar functional outcomes to the traditional Stack technique. Current evidence demonstrates that proper execution of central slip reconstruction can achieve consistent functional results regardless of the technique chosen.
Keywords
vascularized toe joint transfer - proximal interphalangeal joint - central slip reconstruction - extensor mechanism reconstruction - finger joint reconstructionPublication History
Article published online:
13 June 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Chen HY, Lin YT, Lo S, Hsu CC, Lin CH, Wei FC. Vascularised toe proximal interphalangeal joint transfer in posttraumatic finger joint reconstruction: the effect of skin paddle design on extensor lag. J Plast Reconstr Aesthet Surg 2014; 67 (01) 56-62
- 2 Foucher G, Sammut D, Citron N. Free vascularized toe-joint transfer in hand reconstruction: A series of 25 patients. J Reconstr Microsurg 1990; 6 (03) 201-207
- 3 Waughlock N, Hsu CC, Lam WL, Lin YT, Wei FC. Improving the extensor lag and range of motion following free vascularized joint transfer to the proximal interphalangeal joint: Part 1. An observational and cadaveric study. Plast Reconstr Surg 2013; 132 (02) 263e-270e
- 4 Hierner R, Berger AK. Long-term results after vascularised joint transfer for finger joint reconstruction. J Plast Reconstr Aesthet Surg 2008; 61 (11) 1338-1346
- 5 Zhou KJ, Graham DJ, Lawson RD, Sivakumar BS. Toe-to-finger vascularized joint transfers for proximal interphalangeal joint reconstruction: A systematic review. Hand (N Y) 2022; 17 (06) 1031-1038
- 6 Graham WC. Transplantation of joints to replace diseased or damaged articulations in the hand. Am J Surg 1954; 88 (01) 136-141
- 7 Entin MA, Alger JR, Baird RM. Experimental and clinical transplantation of autogenous whole joints. J Bone Joint Surg 1962; 44A (08) 1518-1536
- 8 Buncke Jr HJ, Daniller AI, Schulz WP, Chase RA. The fate of autogenous whole joints transplanted by microvascular anastomoses. Plast Reconstr Surg 1967; 39 (04) 333-341
- 9 Foucher G, Merle M. Transfert articulaire au niveau d’un doigt en microchirurgie. GAM: Lettre d’information du GAM 1976:7
- 10 Tsai T-M, Jupiter JB, Kutz JE, Kleinert HE. Vascularized autogenous whole joint transfer in the hand–a clinical study. J Hand Surg Am 1982; 7 (04) 335-342
- 11 Ellis PR, Hanna D, Tsai TM. Vascularized single toe joint transfer to the hand. J Hand Surg Am 1991; 16 (01) 160-168
- 12 Dautel G, Gouzou S, Vialaneix J, Faivre S. PIP reconstruction with vascularized PIP joint from the second toe: Minimizing the morbidity with the “dorsal approach and short-pedicle technique”. Tech Hand Up Extrem Surg 2004; 8 (03) 173-180
- 13 Lam WL, Waughlock N, Hsu CC, Lin YT, Wei FC. Improving the extensor lag and range of motion following free vascularized joint transfer to the proximal interphalangeal joint: Part 2. A clinical series. Plast Reconstr Surg 2013; 132 (02) 271e-280e
- 14 Lin YT, Loh CYY. A novel technique for correcting extensor lag in vascularized toe PIP joint transfers. Tech Hand Up Extrem Surg 2016; 20 (03) 104-107
- 15 Lin YT. Technical keys in maximizing finger proximal interphalangeal joint motion after vascularized toe joint transfers. J Hand Surg Eur Vol 2019; 44 (07) 667-675
- 16 Lin YT, Kao D, Wan DC, Lien SH, Lin CH, Wei FC. Simultaneous reconstruction of extensor mechanism in free transfer of vascularized PIP joints. Tech Hand Upper Extremity 2012; 17 (01) 20-24
- 17 Peng C, Lee CH, Chen SH. et al. Stack versus te technique for central slip reconstruction during vascularized toe proximal interphalangeal joint transfer. Plast Reconstr Surg 2024; 154 (03) 508e-513e