Capsuloplasty in reconstruction of class II defect of the thumb: observation of clinical outcomes

Abstract

Objective To evaluate the functions of the fingers reconstructed by second toe transplantation and compare the results of two different procedures of transplant fixation: phalangeal fixation or metacarpophalangeal capsuloplasty. Methods Sixteen patients who underwent second toe transplantation for thumb reconstruction in the period from June 2006 to June 2008 were followed and evaluated. All the patients sustained posttraumatic class Ⅱ defect of the thumb. In group A the transferred toe was fixed by phalangeal fixation. The phalanx of the transferred toe was fixed to the remaining part of proximal phalanx of the thumb by a transarticular Kirschner wire. There were 6 cases in this group.The K-wire was removed 4 to 6 weeks postoperatively when rehabilitation started. In group B the transferred toe was fixed to the first metacarpus by a transarticular Kirschner wire and suturing the joint capsule. There were 10 cases in this group. The K-wire was withdrawn 3 weeks after the operation when rehabilitation was initiated. All patients were followed for 3 to 30 months. Results Tendon adhesion which led to impaired flexion of the reconstructed fingers occurred in all cases of group A, constituting 100%. There were 4 cases of postoperative tendon adhesion in group B, accounting for 40%. After tenolysis, the flexion function was improved in 4 cases of group A and 3 cases of group B, constituting 66.7% and 75.0% respectively. The overall effective rate was 81.3% . Conclusion Class II thumb defect between zone A and zone B converted by removing proximal phalanx base and class Ⅱ thumb defect at zone B can be reconstructed with toe transfer by capsuloplasty at the metacarpophalangeal joint. This procedure leads to better results than phalangeal fixation because it facilitates early postoperative rehabilitation and reduces tendon adhesion. Key words: Tissue transplantation; Rehabilitation; Treatment outcome; Tendons