The application of 3D-CTA technology in toe-to-hand transfers

Abstract

Objective To investigate the clinical significance of the application of 3D-CT angiogram(CTA) in toe-to-hand transplantation for thumb and finger reconstruction. Methods From August 2009 to June 2015, 41 partial thumb and finger defects in 33 cases were treated with toe to hand transfer. Preoperatively both feet were scanned using the 3D-CTA technique to establish three-dimensional images of the vasculature. The courses of the arteries and veins at the donor site and their branching patterns were visualized which allowed harvesting of the donor toe tailored to the number of missing fingers, the length of the defect and the size and shape of the skin defects. Results All 41 toe-to-hand transplants in the 33 cases survived. Postoperative follow-up ranged from 3 months to 1 year. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 17 digits, good in 20 digits, fair in 3 digits and poor in 1 digit.The overall satisfactory rate was 90.2%. The appearance and function of the reconstructed thumb and fingers were satisfactory. Conclusion The 3D-CTA technique can help us formulate individualized and more accurate surgical design in toe-to-hand transfer. It greatly reduces surgical risk and improves the survival rate. It has practical and clinical significance in microsurgical reconstruction of the thumb and fingers. Key words: Fingers; Toes; Repair; Digital technology; Microsurgery