Article
Aspects of toe to hand transfers in children with the macrodactyly of the hand
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Published: | February 6, 2020 |
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Objectives/Interrogation: Purpose of the study is to determine the role of microsurgical toe to hand transfer in the treatment of children with isolated macrodactyly, based on a comparative analysis of various types of surgical interventions
Methods: In the department of reconstructive microsurgery from 2013 to 2017, 25 children with congenital macrodactyly of the hand were examined and surgically treated. Out of 25 patients, in 13 there was a macrodactyly of the 2nd, 3rd fingers, which was 52%. At the same time, of the total number of hyperplastic hand segments (n = 45), 17 rays had hyperplasia greater than 25%.
Results and Conclusions: Stage-by-stage modeling resections of enlarged segments were performed in all children with hyperplasia of the ray of about 25% of the size of intact fingers, in 4 cases excision of soft tissues was combined with marginal resection of phalanges. When hyperplasia of the segment reached up to 10% of macrodactyly, it was performed in the child the single isolated modeling resections of soft tissues and bones. Repeated modeling operation in 16% (n = 4) children were accompanied by the formation of gross postoperative scars with the development of secondary angular deformities and loss of functions of interphalangeal joints.
9 patients (n = 14) underwent amputation of hyperplastic fingers followed by microsurgical reconstruction of rays by the method of autografting of the toes. In 4 cases, the first finger was reconstructed. In other 5 cases, two toes of both feet were transplanted to the position of 2, 3 (n = 4) and to the position of 3, 4 fingers (n = 1). It was revealed that with a significant hyperplasia of the affected segments of the hand (1.5 - 2 times), the method of microsurgical autografting of the toes is more effective and acceptable compared to the method of bone and soft tissue resections.
With segment hyperplasia less than a quarter of the normal size, the optimal surgical interventions are stage by stage modeling resection.;
An alternative method of surgical treatment of children with hyperplasia of more than 25% is microsurgical transplantation of the toes into the position of the involved into process rays of the hand, which allows obtaining good cosmetic and functional results in these patients.