Non-vascularized toe phalanges transplantation in congenital hand malformations

Abstract

According to the world literature, congenital malformations of the upper limb are found in 2.3–7.9 per 10 thousand live births, while anomalies in the development of the hand occur in 65–95% of patients, the most common are reduction anomalies (brachydactyly, ectrodactyly, adactyly, hypoplasia). Various methods of reconstructive plastic surgery are known in the world literature, including microsurgery, compression-distraction osteosynthesis, various types of skin, tendon-muscle and bone plasty, as well as prosthetics. Non-vascularized toe phalanges transplantation is a less common method, which is effective and technically accessible in case of reduction anomalies of the hand. This study is aimed at studying the relevance of the application of the presented method based on the analysis of world literature.

The aim of the review is the analysis of the world experience of using non-vascularized toe phalanges transplantation in case of congenital hand malformations. A search was made for literature sources in the open electronic databases PubMed and eLibrary for the last 110 years. The publications devoted to the study of the effectiveness of transplanting the phalanges of the toes into defects of the fingers in clinical practice are analyzed. This method has a number of advantages: low morbidity for the donor foot, minimal risk of resorption of the transplanted graft, restoration of the anatomy of the formed finger, preservation of blood supply and sensitivity in the formed finger, the possibility of phalanx growth while maintaining the growth zone, the functionality of the fingers. At the same time, such issues as the detailed functioning of the growth zone of the non-perfusion phalanx after its transplantation, the reasons for the continuation or cessation of growth in the short term after surgery, the resorption of displaced phalanges, and the dependence of the mobility of the reconstructed fingers on the technology of interventions are not indicated anywhere.

Conducting further research on the role of transplantation of non-vascularized toe phalanges in the pathology of the hand in children seems to be an actual task.

Keywords

children / hand / malformations / bone grafting / non-vascularized toe phalanges transplantation / review

References

[1] msdmanuals.com [Internet]. Boyadjiev Boyd S.A. Introduction to congenital craniofacial and musculoskeletal abnormalities [updated 2020 May 23; cited 2022 May 12]. Medical topics & chapters. Available from: https://www.msdmanuals.com/professional/pediatrics/congenital-craniofacial-and-musculoskeletal-abnormalities/introduction-to-congenital-craniofacial-and-musculoskeletal-abnormalities.

[2] msdmanuals.com [Internet]. Boyadjiev Boyd S.A. Introduction to congenital craniofacial and musculoskeletal abnormalities. [дата обращения: 12.05.2022]. Medical topics & chapters; [около 2 страниц]. Доступ по ссылке: https://www.msdmanuals.com/professional/pediatrics/congenital-craniofacial-and-musculoskeletal-abnormalities/introduction-to-congenital-craniofacial-and-musculoskeletal-abnormalities.

[3] Lamb DW, Wynne-Davies R, Soto L. An estimate of the population frequency of congenital malformations of the upper limb. J Hand Surg Am. 1982;7(6):557–562. doi: 10.1016/s0363-5023(82)80101-9

[4] Lamb D.W., Wynne-Davies R., Soto L. An estimate of the population frequency of congenital malformations of the upper limb // J Hand Surg. 1982. Vol. 7, N 6. P. 557–562. |doi: 10.1016/s0363-5023(82)80101-9

[5] Tyazhelkov AP. Congenital hand malformations with the insuffucient development of the composing elements. Healthcare of the Far East. 2014;(4):65–72. (In Russ).

[6] Тяжелков А.П. Врожденные пороки кисти с недостаточным развитием составляющих элементов // Здравоохранение Дальнего Востока. 2014. № 4. С. 65–72.

[7] Shvedovchenko IV. Lechenie detei s vrozhdennymi porokami razvitiya verkhnikh konechnostei. In: Travmatologiya i ortopediya. Ed by N.V. Kornilov, E.N. Gryaznukhin. Vol. 2. St. Petersburg: Gippokrat; 2005. (In Russ).

[8] Шведовченко И.В. Лечение детей с врожденными пороками развития верхних конечностей. В кн.: Травматология и ортопедия / под ред. Н.В. Корнилова, Э.Н. Грязнухина. Т. 2. Санкт-Петербург : Гиппократ, 2005.

[9] Swanson AB, Swanson GD, Tada K. A classification for congenital limb malformation. J Hand Surg Am. 1983;8(5 Pt 2):693–702. doi: 10.1016/s0363-5023(83)80249-4

[10] Swanson A.B., Swanson G.D., Tada K. A classification for congenital limb malformation // J Hand Surg Am. 1983. Vol. 8, N 5, Pt 2. P. 693–702. doi: 10.1016/s0363-5023(83)80249-4

[11] Tonkin MA. Classification of congenital anomalies of the hand and upper limb. J Hand Surg Eur Vol. 2017;42(5):448–456. doi: 10.1177/1753193417690965

[12] Tonkin M.A. Classification of congenital anomalies of the hand and upper limb // J Hand Surg Eur Vol. 2017. Vol. 42, N 5. P. 448–456. doi: 10.1177/1753193417690965

[13] Codivilla A. On the means of lengthening, in the lower limbs, the muscles and tissues which are shortened through deformity. J Bone Joint Surg Am. 1905;s2-2(4):353–369.

[14] Codivilla A. On the means of lengthening, in the lower limbs, the muscles and tissues which are shortened through deformity // J Bone Joint Surg Am. 1905. Vol. s2-2, N 4. P. 353–369.

[15] Hülsbergen-Krüger S, Preisser P, Partecke BD. Ili-zarov distraction-lengthening in congenital anomalies of the upper limb. J Hand Surg Br. 1998;23(2):192–195. doi: 10.1016/s0266-7681(98)80173-3

[16] Hülsbergen-Krüger S., Preisser P., Partecke B.D. Ilizarov distraction-lengthening in congenital anomalies of the upper limb // J Hand Surg Br. 1998. Vol. 23, N 2. P. 192–195. doi: 10.1016/s0266-7681(98)80173-3

[17] Matev IB. Thumb reconstruction after amputation at the metacarpophalangeal joint by bone-lengthening. A preliminary report of three cases. J Bone Joint Surg. 1970;52(5):957–965. doi: 10.2106/00004623-197052050-00010

[18] Matev I.B. Thumb reconstruction after amputation at the metacarpophalangeal joint by bone-lengthening. A preliminary report of three cases // J Bone Joint Surg. 1970. Vol. 52, N 5. P. 957–965. doi: 10.2106/00004623-197052050-00010

[19] Pensler JM, Carroll NC, Cheng LF. Distraction osteoge-nesis in the hand. Plast Reconstr Surg. 1998;102(1):92–95. doi: 10.1097/00006534-199807000-00014

[20] Pensler J.M., Carroll N.C., Cheng L.F. Distraction osteogenesis in the hand // Plast Reconstr Surg. 1998. Vol. 102, N 1. P. 92–95. doi: 10.1097/00006534-199807000-00014

[21] Seitz WH, Shimko P, Patterson RW. Long-term results of callus distraction-lengthening in the hand and upper extremity for traumatic and congenital skeletal deficiencies. J Bone Joint Surg Am. 2010;92 Suppl 2:47–58. doi: 10.2106/JBJS.J.01106

[22] Seitz W.H., Shimko P., Patterson R.W. Long-term results of callus distraction-lengthening in the hand and upper extremity for traumatic and congenital skeletal deficiencies // J Bone Joint Surg Am. 2010. Vol. 92, Suppl 2. P. 47–58. doi: 10.2106/jbjs.j.01106

[23] Buck-Gramcko D. Congenital malformations of the hand and forearm. Chir Main. 2002;21(2):70–101. doi: 10.1016/s1297-3203(02)00103-8

[24] Buck-Gramcko D. Congenital malformations of the hand and forearm // Chir Main. 2002. Vol. 21, N 2. P. 70–101. doi: 10.1016/s1297-3203(02)00103-8

[25] Kay SP, Wiberg M. Toe to hand transfer in children. Part 1: technical aspects. J Hand Surg Br. 1996;21(6):723–734. doi: 10.1016/s0266-7681(96)80176-8

[26] Kay S.P., Wiberg M. Toe to hand transfer in children. Part 1: technical aspects // J Hand Surg Br. 1996. Vol. 21, N 6. P. 723–734. doi: 10.1016/s0266-7681(96)80176-8

[27] 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(6):735–745. doi: 10.1016/s0266-7681(96)80177-x

[28] Kay S.P., Wiberg M., Bellew M., Webb F. Toe to hand transfer in children. Part 2: Functional and psychological aspects. // J Hand Surg Br. 1996. Vol. 21, N 6. P. 735–745. doi: 10.1016/s0266-7681(96)80177-x

[29] Kotkansalo T, Vilkki S, Elo P. Long-term results of finger reconstruction with microvascular toe transfers after trauma. J Plast Reconstr Aesthet Surg. 2011;64(10):1291–1299. doi: 10.1016/j.bjps.2011.04.036

[30] Kotkansalo T., Vilkki S., Elo P. Long-term results of finger reconstruction with microvascular toe transfers after trauma // J Plast Reconstr Aesthet Surg. 2011. Vol. 64, N 10. P. 1291–1299. doi: 10.1016/j.bjps.2011.04.036

[31] Broadbent TR, Woolf RM. Thumb reconstruction with contiguous skin-bone pedicle graft. A case report. J Plast Reconstr Surg. 1960;26(5):494–499. doi: 10.1097/00006534-196011000-00002

[32] Broadbent T.R., Woolf R.M. Thumb reconstruction with contiguous skin-bone pedicle graft. A case report // J Plast Reconstr Surg. 1960. Vol. 26, N 5. P. 494–499. doi: 10.1097/00006534-196011000-00002

[33] McGregor IA, Simonetta C. Reconstruction of the thumb by composite bone-skin flap. Br J Plast Surg. 1964;17:37–48. doi: 10.1016/s0007-1226(64)80007-2

[34] McGregor I.A., Simonetta C. Reconstruction of the thumb by composite bone-skin flap. // Br J Plast Surg. 1964. Vol. 17. P. 37–48. doi: 10.1016/s0007-1226(64)80007-2

[35] Mowlem R. Bone grafting. Br J Plast Surg. 1963;16:293–304. doi: 10.1016/s0007-1226(63)80133-2

[36] Mowlem R. Bone grafting // Br J Plast Surg. 1963. Vol. 16. P. 293–304. doi: 10.1016/s0007-1226(63)80133-2

[37] Nicoladoni C. Daumenplastik. Wien Klin Wochenschr. 1897;10:663–665. (In German).

[38] Nicoladoni C. Daumenplastik // Wien Klin Wochenschr. 1897. Vol. 10. P. 663–665. (In German).

[39] Timann C. Die Behandlung der Spinaventosamittels freier Autoplastik. Beitr Klin Chir. 1902;36:189–211. (In German).

[40] Timann C. Die Behandlung der Spinaventosamittels freier Autoplastik // Beitr Klin Chir. 1902. Vol. 36. P. 189–211. (In German).

[41] Shvedovchenko IV, Koltsov AA. The improvement of hand function in patients with severe hand underdevelopment by method of free toes phalanx transposition. In: Rehabilitation XXI century: traditions and innovations: Proceedings of the II National Congress with international participation; 2018 Sep 12–13; St. Petersburg, Russia. St. Petersburg: Ministry of Labor of Russia; 2018. P. 158. (In Russ).

[42] Шведовченко И.В., Кольцов А.А. Улучшение функции кисти при тяжелых формах недоразвития методом свободной костной пластики некровоснабжаемых фаланг пальцев стопы. В кн.: Реабилитация XXI век: традиции и инновации: материалы II Нацио-нального конгресса с международным участием; 12-13 сентября 2018 года; Санкт-Петербург, Россия. Санкт-Петербург : Минтруд России, 2018. С. 158.

[43] Buck-Gramcko D, Pereira JA. Proximal toe phalanx transplantation for bony stabilization and lengthening of partially aplastic digits. Ann Chir Main Memb Super. 1990;9(2):107–118. doi: 10.1016/s0753-9053(05)80487-9

[44] Buck-Gramcko D., Pereira J.A. Proximal toe phalanx transplantation for bony stabilization and lengthening of partially aplastic di-gits // Ann Chir Main Memb Super. 1990. Vol. 9, N 2. P. 107–118. doi: 10.1016/s0753-9053(05)80487-9

[45] Buck-Gramcko D. The role of nonvascularized toe phalanx transplantation. Hand Clin. 1990;6(4):643–659. doi: 10.1016/s0749-0712(21)01061-1

[46] Buck-Gramcko D. The role of nonvascularized toe phalanx transplantation // Hand Clin. 1990. Vol. 6, N 4. P. 643–659. doi: 10.1016/s0749-0712(21)01061-1

[47] medscape.com [Internet]. Laub DR. Congenital hand deformities [updated 2021 Mar 24; cited 2022 Apr 12]. Drugs & Diseases > Plastic Surgery [about 2 screens]. Available from: https://emedicine.medscape.com/article/1285233-overview

[48] medscape.com [Internet]. Laub D.R. Congenital hand deformities [дата обращения: 12.04.2022]. Drugs & Diseases > Plastic Surgery [около 2 страниц]. Доступ по ссылке: https://emedicine.medscape.com/article/1285233-overview

[49] Wolff H. Auswechselung von Finger und Zehenknochen: Beitrag zur Autoplastik. Münchener Med Wochenschr. 1911;58:578. (In German).

[50] Wolff H. Auswechselung von Finger und Zehenknochen: Beitrag zur Autoplastik // Münchener Med Wochenschr. 1911. Vol. 58. P. 578. (In German).

[51] Kessler I, Baruch A, Hecht O. Experience with distraction lengthening of digital rays in congenital anomalies. J Hand Surg Am. 1977;2(5):394–401. doi: 10.1016/s0363-5023(77)80049-x

[52] Kessler I., Baruch A., Hecht O. Experience with distraction lengthening of digital rays in congenital anomalies // J Hand Surg Am. 1977. Vol. 2, N 5. P. 394–401. doi: 10.1016/s0363-5023(77)80049-x

[53] Rukovodstvo po protezirovaniyu i ortezirovaniyu. Ed by M.A. Dymochka, A.I. Sukhoverova, B.G. Spivak 3rd ed. Moscow; 2016. (In Russ).

[54] Руководство по протезированию и ортезированию / под ред. М.А. Дымочки, А.И. Суховеровой, Б.Г. Спивака. 3-е изд. Москва, 2016.

[55] Koryukov AA. Sposob podgotovki k protezirovaniyu korotkoi kul’ti kisti. Vestnik vserossiiskoi gil’dii protezistov-ortopedov. 2011;(1):25–26. (In Russ).

[56] Корюков А.А. Способ подготовки к протезированию короткой культи кисти // Вестник всероссийской гильдии протезистов-ортопедов. 2011. № 1. С. 25–26.

[57] Kruglov AV, Shvedovchenko IV. Evaluation of the results of functional prosthetics in children with congenital defects of the hand and fingers. Orthopedics, Traumatology and Reconstructive Surgery of Childhood. 2019;7(2):33–40. (In Russ). doi: 10.17816/PTORS7233-40

[58] Круглов А.В., Шведовченко И.В. Оценка результатов функционального протезирования детей с врожденными дефектами кисти и пальцев // Ортопедия, травматология и восстановительная хирургия детского возраста. 2019. Т. 7, № 2. С. 33–40. doi: 10.17816/PTORS7233-40

[59] Goebel W. Ersatz von Fingergelenken durch Zehengelenke. Münchener Med Wochenschr. 1913:1598–1599. (In German).

[60] Goebel W. Ersatz von Fingergelenken durch Zehengelenke // Münchener Med Wochenschr. 1913. P. 1598–1599. (In German).

[61] Entin MA. Reconstruction of congenital abnormalities of the upper extremities. J Bone Joint Surg Am. 1959;41-A(4):681–701.

[62] Entin M.A. Reconstruction of congenital abnormalities of the upper extremities // J Bone Joint Surg Am. 1959. Vol. 41-A, N 4. P. 681–701.

[63] Carroll RE, Green DP. Reconstruction of the hypoplastic digits using toe phalanges. J Bone Joint Surg Am. 1975;57:727. doi: 10.2106/00004623-197557050-00038

[64] Carroll R.E., Green D.P. Reconstruction of the hypoplastic digits using toe phalanges // J Bone Joint Surg Am. 1975. Vol. 57. P. 727. doi: 10.2106/00004623-197557050-00038

[65] Goldberg NH, Watson HK. Composite toe (phalanx and epiphysis) transfers in the reconstruction of the aphalangic hand. J Hand Surg Am. 1982;7(5):454–459. doi: 10.1016/s0363-5023(82)80039-7

[66] Goldberg N.H., Watson H.K. Composite toe (phalanx and epiphysis) transfers in the reconstruction of the aphalangic hand // J Hand Surg Am. 1982. Vol. 7, N 5. P. 454–459. doi: 10.1016/s0363-5023(82)80039-7

[67] Radocha RF, Netscher D, Kleinert HE. Toe phalangeal grafts in congenital hand anomalies. J Hand Surg Am. 1993;18(5):833–841. doi: 10.1016/0363-5023(93)90050-d

[68] Radocha R.F., Netscher D., Kleinert H.E. Toe phalangeal grafts in congenital hand anomalies // J Hand Surg Am. 1993. Vol. 18, N 5. P. 833–841. doi: 10.1016/0363-5023(93)90050-d

[69] Cavallo AV, Smith PJ, Morley S, Morci AW. Non-vascularized free toe phalanx transfers in congenital hand deformities the Great Ormond Street experience. J Hand Surg Br. 2003;28(6):520–527. doi: 10.1016/s0266-7681(03)00084-6

[70] Cavallo A.V, Smith P.J., Morley S., Morci A.W. Non-vascularized free toe phalanx transfers in congenital hand deformities the Great Ormond Street experience // J Hand Surg Br. 2003. Vol. 28, N 6. P. 520–527. doi: 10.1016/s0266-7681(03)00084-6

[71] Gohla T, Metz Ch, Lanz U. Non-vascularized free toe phalanx transplantation in the treatment of symbrachydactyly and constriction ring syndrome. J Hand Surg Br. 2005;30(5):446–451. doi: 10.1016/j.jhsb.2005.06.003

[72] Gohla T., Metz Ch., Lanz U. Non-vascularized free toe phalanx transplantation in the treatment of symbrachydactyly and constriction ring syndrome // J Hand Surg Br. 2005. Vol. 30, N 5. P. 446–451. doi: 10.1016/j.jhsb.2005.06.003

[73] Unglaub F, Lanz U, Hahn P. Outcome analysis, including patient and parental satisfaction, regarding nonvascularized free toe phalanx transfer in congenital hand deformities. Ann Plast Surg. 2006;56(1):87–92. doi: 10.1097/01.sap.0000188109.65963.42

[74] Unglaub F., Lanz U., Hahn P. Outcome analysis, including patient and parental satisfaction, regarding nonvascularized free toe phalanx transfer in congenital hand deformities // Ann Plast Surg. 2006. Vol. 56, N 1. P. 87–92. doi: 10.1097/01.sap.0000188109.65963.42

[75] Ozkan T, Kuvat SV, Aydin A, Bicer A. Nonvascular phalangeal transfer from toes to hand in congenital aphalangia. J Acta Orthop Traumatol Turc. 2007;41(1):36–41. (In Turkish).

[76] Ozkan T., Kuvat S.V., Aydin A., Bicer A. Nonvascular phalangeal transfer from toes to hand in congenital aphalangia // J Acta Orthop Traumatol Turc. 2007. Vol. 41, N 1. P. 36–41. (In Turkish).

[77] Tonkin MA, Deva AK, Filan SL. Long term follow-up of composite non-vascularized toe phalanx transfers for aphalangia. J Hand Surg Br. 2005;30(5):452–458. doi: 10.1016/j.jhsb.2005.06.001

[78] Tonkin M.A., Deva A.K., Filan S.L. Long term follow-up of composite non-vascularized toe phalanx transfers for aphalangia // J Hand Surg Br. 2005. Vol. 30, N 5. P. 452–458. doi: 10.1016/j.jhsb.2005.06.001

[79] Garagnani L, Gibson M, Smith PJ, Smith GD. Long-term donor site morbidity after free nonvascularized toe phalangeal transfer. J Hand Surg Am. 2012;37(4):764–774. doi: 10.1016/j.jhsa.2011.12.010

[80] Garagnani L., Gibson M., Smith P.J., Smith G.D. Long-term donor site morbidity after free nonvascularized toe phalangeal transfer // J Hand Surg Am. 2012. Vol. 37, N 4. P. 764–774. doi: 10.1016/j.jhsa.2011.12.010

[81] Kawabata H, Tamura D. 5- and 10-year follow-up of nonvascularized toe phalanx transfers. J Hand Surg Am. 2018;43(5):485.e1–485.e5. doi: 10.1016/j.jhsa.2017.10.034

[82] Kawabata H., Tamura D. 5- and 10-year follow-up of nonvascularized toe phalanx transfers // J Hand Surg Am. 2018. Vol. 43, N 5. P. 485.e1–485.e5. doi: 10.1016/j.jhsa.2017.10.034

[83] Bourke G, Kay SP. Free phalangeal transfer: donor-site outcome. Br J Plast Surg. 2002;55(4):307–311. doi: 10.1054/bjps.2002.3836

[84] Bourke G., Kay S.P. Free phalangeal transfer: donor-site outcome // Br J Plast Surg. 2002. Vol. 55, N 4. P. 307–311. doi: 10.1054/bjps.2002.3836

[85] Naran S, Imbriglia JE. Case report: 35-year follow-up for nonvascularized toe phalangeal transfer for multiple digit symbrachydactyly. Hand (N Y). 2016;11(4):NP38–NP40. doi: 10.1177/1558944716658748

[86] Naran S., Imbriglia J.E. Case report: 35-year follow-up for nonvascularized toe phalangeal transfer for multiple digit symbrachydactyly // Hand (N Y). 2016. Vol. 11, N 4. P. NP38–NP40. doi: 10.1177/1558944716658748

[87] Chow CS, Ho PC, Tse WL, Hung LK. Reconstruction of hypoplastic thumb using hemi-longitudinal metatarsal transfer. J Hand Surg Eur Vol. 2012;37(8):738–744. doi: 10.1177/1753193411432677

[88] Chow C.S., Ho P.C., Tse W.L., Hung L.K. Reconstruction of hypoplastic thumb using hemi-longitudinal metatarsal transfer // J Hand Surg Eur Vol. 2012. Vol. 37, N 8. P. 738–744. doi: 10.1177/1753193411432677

[89] Nakada MA, Tada K, Nakajima T, et al. Case of a 5-year-old boy with a blauth type IIIB hypoplastic thumb reconstructed with a nonvascularized, hemilongitudinal metatarsal transfer. Case Rep Orthop. 2018;2018:8205285. doi: 10.1155/2018/8205285

[90] Nakada M.A., Tada K., Nakajima T., et al. Case of a 5-year-old boy with a blauth type IIIB hypoplastic thumb reconstructed with a nonvascularized, hemilongitudinal metatarsal transfer // Case Rep Orthop. 2018. Vol. 2018. P. 8205285. doi: 10.1155/2018/8205285

Funding

Правительство РФGovernment of the Russian Federation(122012700136-1)

RIGHTS & PERMISSIONS

Eco-Vector