Free vascularised transfer of a metatarsophalangeal joint to the hand. A technical modification.

We describe the vascularised transfer of a second metatarsophalangeal joint to the hand to correct a congenital deformity in a thirteen-year-old boy. Technical refinements are described, allowing inversion of the joint to the optimal position for subsequent mobility and retention of a large overlying dorsalis pedis flap to provide adequate cover.

Vascular metatarsophalangeal to ankylosed temporomandibular joint replacement.

Four cases of unilateral temporomandibular (TM) joint ankylosis were successfully treated by metatarsophalangeal to TM joint replacement by microvascular technique. Results 6 to 20 months postoperatively were encouraging. Further follow-up studies are necessary to evaluate the long-term results.

[Autoplastic foot-to-hand joint transplantations]. / Transplantations articulaires autoplastiques du pied à la main.

Our surgical experience in the field of total and partial foot-to-hand joint transplants has evolved over the past 9 years (1973). In the case of serious traumatic injury of finger joints of the hand, we don't suggest any surgical solution other than that of arthrodesis or arthroplasty of the damaged joint. In our experience joint transplantation is a reconstructive operation of the whole functionality of the injured finger. This operation partially restores the active function of the finger involved and gives both the patient and the surgeon the possibility of an alternative to arthrodesis, arthroplasty or painful instability of the destroyed joint, thus avoiding their characteristic disabilities. The transplantation guarantees a true stability of the joint and in the majority of cases the disappearance of pain. The technique described are the result of our experience in treating our clinical cases which consist of 20 patients treated, over more than 9 years at the Division of Hand Surgery of Traumatologic and Orthopaedic Center of Turin. The total number of transposed joints is 22, 16 of which are hemiarticular grafts. The operations have concerned 8 M.P. and 14 PIP joints of the fingers.

Microvascular joint transplantation with epiphyseal growth.

The successful free microvascular transplantation to the hand of a second metatarsal phalangeal joint with associated epiphyses is described, with follow-up data 2 1/2 years later indicating epiphyseal growth.

Free composite tissue transfer in a compound hand injury.

In a severe compound and contaminated injury of the hand with loss of soft and bony tissues, restoration of function was obtained by a free composite vascularised tissue transfer.

Reconstruction of metacarpophalangeal joint by free vascularized autogenous metatarsophalangeal joint transplant.

Six cases of autotransplantation of free vascularized second metatarsophalangeal joint to reconstruct damaged metacarpophalangeal (MP) joints are reported. Anatomical studies in cadaver and clinical cases involving the origin, course, and importance of preserving the articular branch of the metatarsal artery are described. Follow-up of cases from six months to 21/2 years postoperative reveal recovery of thumb function, stability of the transplanted joint, and no obvious degenerative changes.

Long-term follow-up of free vascularized joint transfers to the hand in children.

Toe-to-hand vascularized joint transfers in four children were reviewed 6 to 8 years after operation (average, 6.6 years). Two children had vascularized metatarsophalangeal (MTP) joints. Both children have near normal active range of motion. The transferred epiphyses have provided a major contribution to digital growth. The other two children had second toe proximal interphalangeal (PIP) joints transferred to damaged hand joints. Active PIP joint extension has been disappointing, and the overall growth contribution of the transferred epiphysis has been small. We conclude that MTP to metacarpophalangeal vascularized joint transfer can provide painless, functional, stable motion, with near normal growth potential, and the usefulness of toe PIP to hand PIP joint transfer is limited by the inability to achieve good active extension and limited growth potential.

Free vascularized small joint transfer to the hand.

Free vascularized digital joint transfers should provide joint stability, painless functional range of motion (ROM), tolerance of normal stresses without degeneration, and growth potential in children. In our department since 1977, seven transfers have been carried out in seven patients, including four children aged 4 to 11 years and three adults aged 19 to 46 years. Donor sites were the metatarsophalangeal joint of the second toe (four cases), the proximal interphalangeal (PIP) joint of the second toe (two cases), and the PIP joint of a useless amputated small finger (one case). Recipient sites were digital PIP and metacarpophalangeal (MP) joints (three cases each) and the MP joint of a thumb (one case). Six of the seven procedures were successful. There was retention of normal joint space and stable, painless functional ROM, while epiphyseal centers in the children remained open and showed normal growth. Follow-up ranged from 2 to 4.7 years, averaging 3.5 years. Some adherence of an associated extensor tendon has been observed. The feet have been asymptomatic. When digital joint replacement is required because of local causes of destruction, free toe joint transfer should certainly be considered in children and in young adults.

Digital distraction lengthening followed by free vascularized epiphyseal joint transfer.

This is the first report of combined digital distraction lengthening followed by free vascularized metatarsophalangeal joint transfer. This restored mobility, stability, length, and growth potential in the ring finger of the mutilated hand in a child.