Nonvascularized toe-phalange transplantation to the hand in congenital and acquired pathology (Part 1)

Abstract

BACKGROUND: Restoration of the form and function of underdeveloped fingers in congenital pathology and consequences of severe trauma remains an unsolved problem, especially in young children during growth.
 AIM: To evaluate the feasibility of surgical treatment in children with congenital and acquired hand pathology using transplantation of the nonvascularized phalanges of the toes.
 MATERIALS AND METHODS: We analyzed the immediate surgical treatment results of 41 children at the age of 10 months to 11 years with congenital malformations and posttraumatic hand deformities after undergoing nonvascularized toe-phalange transplantation. The main group of interventions was performed in children with ectrodactyly, adactyly, and hypoplasia of the hand. Predominantly, the proximal phalanges of the I, II, and III fingers were restored. The proximal and middle phalanges of the 2nd and 4th toes were mainly used as transplants.
 RESULTS: We assessed indications and contraindications for nonvascularized toe-phalange transplantation in the treatment of patients with congenital and acquired pathology of the hand. The technologies for performing reconstructive operations have been developed, and the optimal sequence of actions has been determined. The next publication will be devoted to the analysis of the data obtained.
 CONCLUSIONS: Nonvascularized toe-phalange transplantation in the treatment of patients with congenital and acquired pathology of the hand is a method that should be studied from the point of view of indications, technology of execution, as well as long-term results. The undoubted advantage of the discussed technology is the execution available for the surgeon of standard training, as well as the absence of the need for expensive material and technical support, including an operating microscope, specialized instrumentation and suture materials.