Tuesday, May 28, 2013

Toe Transfers

Symbrachydactyly may present in different forms although the thumb is typically well formed.  Reconstructive technique are varied and can include free toe transfers as I have previously written
http://congenitalhand.wustl.edu/2013/01/toe-transfers.html .

I recently saw a symbrachydactyly patient back for followup 10 years after initial treatment.  We had, after a lengthy family discussion in 2003, treated the 9 month old patient with a nonvascularized toe phalanx transfer.  There are a few reports in the literature detailing positive outcomes with growth of the transferred bone (although more recent reports are not so positive).  I no longer have great confidence in this procedure because the transferred bone does not seem  grow after transfer to the hand.  Nonetheless, 10 years ago, we elected to perform this procedure to give the child a post to pinch against with the thumb.  Even today, I do believe this procedure should be considered but perhaps at a slightly older age when the bone need not grow significantly to be helpful.

Symbrachydactyly x- rays before surgery.  Note that thumb is well formed but all other digits are short.  We felt that providing a bit of length to the index finger would help with function.

Symbrachydactyly x-rays just after transfer of a nonvascularized toe phalanx.  The length of the index finger looks great.
Symbrachydactyly x- rays 1 year after surgery.  Note that index finger is no longer as long as previously with absorption of the index finger added bone.








10 years after free toe transfer.  Note that the transferred bone is  no longer visible.
Appearance of the hand at 10 year follow- up.

Palm side view of hand 10 years after surgery.



Patient making a fist 10 years after free toe transfer.

Free toe transfer donor site 10 years after surgery.  The patient and family do not really like the appearance of the foot.

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