Microsurgical Second Toe-Metatarsal Bone Transfer for Reconstructing Congenital Radial Deficiency with Hypoplastic Thumb

This study describes a consecutive series of 11 children who received a microsurgical second toe-metatarsal bone transfer for reconstructing a hypoplastic thumb associated with radial club hand, between 1996 and 2000. The parents refused pollicization in all cases for aesthetic and cultural reasons. Surgery was intended to improve hand function and cosmetic appearance. The average patient age was 3 years, and the average follow-up period was 4 years. Average surgery time for the second toe-metatarsal bone transplantation was 8 hr. The primary success rate was 90.9 percent, with one patient requiring repeat surgery owing to venous occlusion. The surgical outcomes reveal a normal growth of the transferred toe, an acceptable range of motion, and satisfactory recovery of sensation. All children achieved both small and large grasp functions. The parents were satisfied with the reconstruction procedures. Based on the preliminary results, second toe-metatarsal bone transfer appears an acceptable alternative for reconstructing radial deficiency with hypoplastic thumb.

KEYWORDS

Radial club hand - hypoplastic thumb - second toe-metatarsal bone flap - microsurgical toe transfer

REFERENCES

• 1 Lister G. Pollex abductus in hypoplasia and duplication of the thumb.  J Hand Surg. 1991;  16A 626-633
• 2 Scheker L R, Cendale L C. Correcting congenital thumb anomalies in children: opponensplasty and pollicization. In: Gupta A, Kay SPJ, Scheker LR The Growing Hand. London; Mosby 2000: 171-182
• 3 Blauth W. Der hypoplastische daumen.  Arch Orthop Unfall-Chir. 1967;  62 225-246
• 4 Manske P R, McCarroll Jr H R. Reconstruction of the congenitally deficient thumb.  Hand Clin. 1992;  8 177-196
• 5 Swanson A B. A classification for congenital limb malformations.  J Hand Surg. 1976;  1A 8-22
• 6 Bayne L G, Klug M S. Long-term review of the surgical treatment of radial deficiencies.  J Hand Surg. 1987;  12A 169-179
• 7 Flatt A E. Radial club hand. In: Flatt AE The Care of Congenital Anomalies, 2nd ed. St Louis; Quality Medical Publishing 1994: 366-410
• 8 Kay S P, Wiberg M, Bellew M, Webb F. Toe-to-hand transfer in children. Part 2: Functional and psychological aspects.  J Hand Surg. 1996;  21B 735-745
• 9 Shibata M. Metatarsophalangeal joint transfer for type IIIB hypoplastic thumb. In: Gupta A, Kay SPJ, Scheker LR The Growing Hand. London; Mosby 2000: 183-188
• 10 Littler J W. On making a thumb. One hundred years of surgical efforts.  J Hand Surg. 1976;  1A 35-51
• 11 Littler J W. The neurovascular pedicle method of digital transposition for reconstruction of the thumb.  Plast Reconstr Surg. 1953;  12 303-319
• 12 Littler J W. Digital transposition.  Curr Pract Orthop Surg.. 1966;  3 157-172
• 13 Clark D I, Chell J, Davis T R. Pollicization of the index finger. A 27 year follow-up study.  J Bone Joint Surg. 1998;  80B 631-635
• 14 Kay S P, Wiberg M. Toe to hand transfer in children. Part 1. Technical aspects.  J Hand Surg. 1996;  21B 723-734
• 15 Buncke G M, Buncke H J, Oliva A, Lineaweaver W C, Siko P P. Hand reconstruction with partial toe and multiple transplants.  Clin Plast Surg. 1992;  19 859-870
• 16 Wei F C, Colony L H, Chen H C, Chuang C C, Noordhoff M S. Combined second and third toe transfer.  Plast Reconstr Surg. 1989;  84 651-661
• 17 Vilkki S. Advances in microsurgical reconstruction of the congenitally adactylous hand.  Clin Orthop. 1995;  314 44-58
• 18 Bradbury E T, Kay S P, Tighe C, Hewison J. Decision-making by parents and children in pediatric hand surgery.  Br J Plast Surg. 1994;  47 324-330
• 19 Wilson R C, Yates A PB. Pediatric microvascular surgery anesthetic experience of 27 toe-to-hand transfers.  Pediatr Anesth. 1993;  3 209-215
• 20 Royle N D. An operation for paralysis of the intrinsic muscles of the thumb.  JAMA. 1938;  111 612
• 21 Huber E. Hilfsoperation bei Medianuslahmung.  Dtsch Z Chir. 1921;  162 271-275
• 22 Cobbett J R. Free digital transfer. Report of a case transfer of a great toe to replace an amputated thumb.  J Bone Joint Surg. 1969;  51B 677-679
• 23 Bunke H J, Bunke C M, Schulz W P. Immediate Nicoladoni procedure in Rhesus monkey hallux-to-hand transplantation utilizing microminiature anastomosis.  Br J Plast Surg. 1966;  19 332-337
• 24 Wei F C, El-Gammal T A, Lin C H, Chuang C C, Chen H C, Chen S H. Metacarpal hand: classification and guidelines for microsurgical reconstruction with toe transfers.  Plast Reconstr Surg. 1999;  99 122-128
• 25 Wei F C, El-Gammal T A, Chen H C, Chuang C C, Chiang Y C, Chen S H. Toe-to-hand transfer for traumatic digital amputations in children and adolescents.  Plast Reconstr Surg. 1997;  100 605-609
• 26 Wei F C, Strauch R J, Chen H C, Chuang C C. Reconstruction of four damaged or destroyed ipsilateral fingers with free toe-to-hand transplantations.  Plast Reconstr Surg. 1994;  93 608-614
• 27 Gilbert A. Toe transfers for congenital hand defects.  J Hand Surg. 1982;  7A 118-126
• 28 Boyer M I, Mih A D. Microvascular surgery in the reconstruction of congenital hand anomalies.  Hand Clin. 1998;  14 135-142
• 29 Van Holder C, Giele H, Gilbert A. Double second toe transfer in congenital hand anomalies.  J Hand Surg. 1999;  24B 471-475
• 30 Spokevicius S, Radzevicius D. Late toe-to-hand transfer for the reconstruction of congenital defects of the long fingers.  Scand J Plast Reconstr Surg Hand Surg. 1997;  31 345-350
• 31 O'Brien B M, Black M J, Morrison W A, MacLeod A M. Microvascular great toe transfer for congenital absence of the thumb.  Hand. 1978;  10 113-124
• 32 Nyarady J, Szekeres P, Vilmos Z. Toe-to-thumb transfer in congenital grade III thumb hypoplasia.  J Hand Surg. 1983;  8A 898-901
• 33 Berger A. Reconstruction of the thenar muscles by microsurgery.  Scand J Plast Reconstr Surg. 1986;  20 153-155
• 34 Shibata M, Yoshizu T, Seki T, Goto M, Saito H, Tajima T. Reconstruction of a congenital hypoplastic thumb with use of a free vascularized metatarsophalangeal joint.  J Bone Joint Surg. 1998;  80A 1469-1476
• 35 Eaton C J, Lister G D. Toe transfer for congenital hand defects.  Microsurgery. 1991;  12 186-195
• 36 Bowen C VA, Ethridge C P, O'Brien B M, Frykman G K, Gumley G J. Experimental microvascular free growth plate transfers. Part 1-Investigation of vascularity.  J Bone Joint Surg. 1988;  70B 305-310
• 37 Zaleske D J, Ehrlich M G, Piliero C et al.. Growth plate behavior in whole joint replantation in rabbit.  J Bone Joint Surg. 1982;  64A 249-257
• 38 Rayner C R. Microsurgery in the treatment of congenital hand deformities. In: Meyer VE, Black JM Microsurgical Procedures. London; Churchill Livingstone 1991: 240-253
• 39 Lister G D. Microsurgical transfer of the second toe for congenital deficiency of the thumb.  Plast Reconstr Surg. 1988;  82 658-665