Long-Term Evaluation of The Functional and Esthetical Outcomes for The New Method of The Toe-To-Hand Transfer for Full-Length Thumb Reconstruction in Congenital Thumb’s Hypoplasia in Children

Open access

Abstract

Congenital thumb hypoplasia is a rare deformity of the upper extremity. Incidence of thumb hypoplasia type I–V was 2–3 and type IIIb-V was 0.5–1 per 20 000 newborns per year in Latvia. The classification of thumb hypoplasia was created by Blauth in 1967 (type I to V). The base of the metacarpal bone is absent for hypoplasia type IIIb–V; therefore, toe-to hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for successful toe-to-hand transplantation. A technique for toe-to-hand transplantation for thumb hypoplasia type IIIb–V patients has been described in literature but overall results were not better than pollicisation. The aim of this study is to describe a new technique for thumb reconstruction with a second toe transfer with metatarsophalangeal joint arthrodesis, which can provide a 5-digit hand and restore the functionality of the thumb for thumb hypoplasia IIIb–V. Long-term follow up was done to evaluate the functions and aesthetics of the hands. A survey to evaluate aesthetical outcome for the transplantation method and pollicisation method was completed by 290 respondents. The overall population rated the aesthetic outcomes of the new transplantation method significantly higher than for pollicisation (p < 0.0001).

Buck-Gramcko, D. (1971). Pollicization of the index finger. J. Bone Joint Surg., 53 (8), 1605–1617.

Chow, C., Ho, P., Tse, W., Hung, L. (2012). Reconstruction of hypoplastic thumb using hemi-longitudinal metatarsal transfer. J. Hand Surgery (European Volume), 37 (8), 738–744.

Chow, C. S., Ho, P. C., Tse, W. L., Hung, L. K. (2012). Reconstruction of hypoplastic thumb using hemi-longitudinal metatarsal transfer. J. Hand Surg. Eur., 37 (8), 738–744.

Foucher, G., Medina, J., Navarro, R. (2001). Microsurgical reconstruction of the hypoplastic thumb, type IIIB. J. Reconstr. Microsurg., 17 (01), 009–016.

Foucher, G., Medina, J., Navarro, R. (2001). Microsurgical reconstruction of the hypoplastic thumb, type IIIB. J. Reconstr. Microsurg., 17 (1), 9–15.

Jones, N. F., Hansen, S. L., Bates, S. J. (2007). Toe-to-hand transfers for congenital anomalies of the hand. Hand Clinics, 23 (1), 129–136.

Jones, N. F., Kaplan, J. (2013). Indications for microsurgical reconstruction of congenital hand anomalies by toe-to-hand transfers. Hand, 8 (4), 367–374.

Light, T. R., Gaffey, J. L. (2010). Reconstruction of the hypoplastic thumb. J. Hand Surg. Amer., 35 (3), 474–479.

Lightdale-Miric, N., Mueske, N. M., Lawrence, E. L., Loiselle, J., Berggren, J., Dayanidhi, S., Stevanovic, M., Valero-Cuevas, F. J., Wren, T. A. L. (2015). Long term functional outcomes after early childhood pollicization. J. Hand Ther., 28 (2), 158–166.

Ozols, D., Zarins, J., Petersons, A. (2018). Bilateral second toe transfers to reconstruct radial longitudinal deficiency: A case report. J. Hand Surg. Eur., 43 (10), 1114–1116.

Riley, S. A., Burgess, R. C. (2009). Thumb hypoplasia. J. Hand Surg. Amer., 34 (8), 1564–1573.

Shibata, M., Yoshizu, T., Seki, T., Goto, M., Saito, H., Tajima, T. (1998). Reconstruction of a congenital hypoplastic thumb with use of a free vascularized metatarsophalangeal joint. J. Bone Joint Surg. Amer., 80 (10), 1469–1476.

Soldato, F., Zlotolow, D. A., Kozin, S. H. (2014). Thumb hypoplasia. J. Hand Surg., 38 (7), 1435–1444.

Staines, K. G., Majzoub, R., Thornby, J., Netscher, D. T. (2005). Functional outcome for children with thumb aplasia undergoing pollicization. Plast Reconstr. Surg., 116 (5), 1314–1323; discussion 1324–1315.

Tan, J., Tum Y.-K. (2013). Comparative study of outcomes between pollicization and microsurgical second toe-metatarsal bone transfer for congenital radial deficiency with hypoplastic thumb. J. Reconstr. Microsurg., 29 (9), 587–592.

Tonkin, M. (2011). Surgical reconstruction of congenital thumb hypoplasia. Indian J. Plast. Surg., 44 (2), 253–265.

Trist, N. D., Tonkin, M. A., van der Spuy, D. J., Yoon, A., Singh, H. P., Law-son, R. D. (2015). Stability of the basal joints of the new thumb after pollicization for thumb hypoplasia. J. Hand Surg. Amer., 40 (7), 1318–1326.

Tu, Y.-K., Yeh, W.-L., Sananpanich, K., Ueng, S. W.-N., Chou, Y.-C., Ma, C.-H., Lee, Z.-L. (2004). Microsurgical second toe-metatarsal bone transfer for reconstructing congenital radial deficiency with hypoplastic thumb. J. Reconstr. Microsurg., 20 (03), 215–225.

Tu, Y. K., Yeh, W. L., Sananpanich, K., Ueng, S. W., Chou, Y. C., Ma, C. H., Lee, Z. L. (2004). Microsurgical second toe-metatarsal bone transfer for reconstructing congenital radial deficiency with hypoplastic thumb. J. Reconstr. Microsurg., 20 (3), 215–225.

Vilkki, S. K. (2008). Vascularized metatarsophalangeal joint transfer for radial hypoplasia. Semin. Plast. Surg., 22 (3), 195–212.

Journal Information

CiteScore 2017: 0.22

SCImago Journal Rank (SJR) 2017: 0.127
Source Normalized Impact per Paper (SNIP) 2017: 0.211

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 53 53 28
PDF Downloads 39 39 21