gms | German Medical Science

Objectives/Interrogation: As an alternative to pollicization, Chow et described a non-vascularized longitudinal hemi-metatarsal second toe transfer to reconstruct the CMC joint of the Blauth grade IIIb or IV hypoplastic thumb. Previously others described the whole second toe MTPJ transfer. We describe the novel microsurgical vascularized longitudinal hemi-metatarsal second toe transfer to reconstruct the CMC joint based on the dorsal metatarsal artery system, in Blauth grade III-IV thumbs or to provide vascularized growing bone grafts (VBG) in children.

Methods: We performed a retrospective analysis of nine patients who underwent vascularized longitudinal hemi-metatarsal second toe transfer at the Oxford University NHS Hospital Trust from December 2015 to December 2017. We will present the technique of harvesting and transfer, outcomes and the secondary surgery.

Results and Conclusions: Six hypoplastic thumbs Blauth grade IIIb-IV were reconstructed with a microsurgical vascularized longitudinal hemi-metatarsal second toe transfer. Three hemi-metatarsal VBG's were performed to create digits in nubbins-type symbrachydactyly. Successful transfer of the split portions of the second toes occurred in all patients. Stable yet mobile CMC joint reconstruction occurred in all cases. Preservation of a fully functioning second toe is reported in all cases. Future secondary surgery will be required to improve functional mobility and use in the thumbs.

For those patients whose parents refuse pollicisation or whom present later in life, we report that microsurgical reconstruction of the severely hypoplastic thumb is possible using longitudinally split second toe metatarsal. When children require growing bone, the vascularized split second toe metatarsal reliably provides this with minimal donor site morbidity.