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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Long Term Outcomes of Congenital Hand Reconstruction Using Free Toe Phalanx Transfer Results in Minimal Donor Site Morbidity

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  • presenting/speaker William Seitz - Cleveland Clinic, Cleveland, United States
  • Noah Raizman - Orthopaedic Medicine and Surgery, Washington DC, United States
  • Adam Meisel - MidAmerica Orthopaedics, Palos Hills, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-756

doi: 10.3205/19ifssh0042, urn:nbn:de:0183-19ifssh00429

Published: February 6, 2020

© 2020 Seitz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives: A report of pain & dissatisfaction in foot function in children having undergone free toe phalanx transfer as part of the reconstruction process for congenital hand difference has been recently reported. Having performed over 200 such procedures over 28 years, the authors have not appreciated this complication. We hypothesized using our technique of a dorsal approach with extensor tendon splitting, extra periosteal sharp dissection, careful flexor tendon preservation and extensor tendon repair, there is little, if any morbidity or functional impairment following free toe phalanx transfer.

Methods: 44 children with multiple toe phalanx transfers at least two years post- surgery were administered the Oxford Ankle Foot Questionnaire for Children (OXAFQ-C)as appropriate, as well as the Foot and Ankle Ability Measure (FAAM). The patients families were also asked whether they were satisfied with the overall outcome of the surgical treatment, would they undergo the same treatment again, whether the upper extremity outcome justified the lower extreme morbidity (if any), and would they recommend the same surgical treatment to another child/family with a similar condition. All date was collected and analyzed by independent observers who had not participated in the care of the patients.

Result: Almost universally, pain, function, activities, sports, footwear, were rated extremely highly (<1.0) Satisfaction in all areas was high (1.0), the only sense of mild dissatisfaction was in appearance (3.4), and having others at some time being unkind (4.2). Every patient / family (44/44) said they would go through the surgery again and would recommend it to others.

Conclusion: Free toe Phalangeal transfer using the 2nd & 3rd toes of one or both feet can provide needed functional bone stock to congenitally hypoplastic digits as part of the reconstruction process. When performed carefully using a dorsal, extra periosteal approach with protection / preservation of the flexor tendon minimal foot complications and a high satisfaction rate can be expected.