Nonvascularized toe-phalange transplantation to the hand in congenital and acquired pathology (Part 1)

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Abstract

BACKGROUND: Restoration of the form and function of underdeveloped fingers in congenital pathology and consequences of severe trauma remains an unsolved problem, especially in young children during growth.

AIM: To evaluate the feasibility of surgical treatment in children with congenital and acquired hand pathology using transplantation of the nonvascularized phalanges of the toes.

MATERIALS AND METHODS: We analyzed the immediate surgical treatment results of 41 children at the age of 10 months to 11 years with congenital malformations and posttraumatic hand deformities after undergoing nonvascularized toe-phalange transplantation. The main group of interventions was performed in children with ectrodactyly, adactyly, and hypoplasia of the hand. Predominantly, the proximal phalanges of the I, II, and III fingers were restored. The proximal and middle phalanges of the 2nd and 4th toes were mainly used as transplants.

RESULTS: We assessed indications and contraindications for nonvascularized toe-phalange transplantation in the treatment of patients with congenital and acquired pathology of the hand. The technologies for performing reconstructive operations have been developed, and the optimal sequence of actions has been determined. The next publication will be devoted to the analysis of the data obtained.

CONCLUSIONS: Nonvascularized toe-phalange transplantation in the treatment of patients with congenital and acquired pathology of the hand is a method that should be studied from the point of view of indications, technology of execution, as well as long-term results. The undoubted advantage of the discussed technology is the execution available for the surgeon of standard training, as well as the absence of the need for expensive material and technical support, including an operating microscope, specialized instrumentation and suture materials.

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About the authors

Igor V. Shvedovchenko

Federal Scientific Center of Rehabilitation Disabled People named after G.A. Albrecht

Email: schwed.i@mail.ru
ORCID iD: 0000-0003-4618-328X
SPIN-code: 3326-0488
ResearcherId: P-9817-2015

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, 50 Bestughevskaya str., Saint Petersburg, 195067

Andrey A. Koltsov

Federal Scientific Center of Rehabilitation Disabled People named after G.A. Albrecht

Email: katandr2007@yandex.ru
ORCID iD: 0000-0002-0862-8826
SPIN-code: 2767-3392

MD, Cand. Sci. (Med.)

Russian Federation, 50, Bestughevskaya street, Sankt-Petersburg, 195067

Pavel A. Matveev

Federal Scientific Center of Rehabilitation Disabled People named after G.A. Albrecht

Email: p-matveyev@narod.ru
ORCID iD: 0000-0002-0455-740X
SPIN-code: 2026-3460

MD, PhD student

Russian Federation, 50 Bestughevskaya str., Saint Petersburg, 195067

Alexandra V. Komarova

Federal Scientific Center of Rehabilitation Disabled People named after G.A. Albrecht

Author for correspondence.
Email: vai_dod@mail.ru
ORCID iD: 0000-0002-2350-4661

MD

Russian Federation, 50, Bestughevskaya street, Sankt-Petersburg, 195067

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Supplementary files

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2. Fig. 1. Isolation and subsequent collection of the proximal phalanx of toe IV: a: incisional scheme of the integumentary tissues; b: fixation of the nail and middle phalanges of finger IV with the preservation of diastasis relative to the head of the metatarsal bone; c: the foot after wound suturing

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3. Fig. 2. Transplantation of the non-vascularized proximal phalanx of toe IV into the position of the proximal phalanx of the finger I in case of adactyly: a: view of the hand before intervention; b: scheme of the skin incision; c: after elimination of flexion contracture and flap displacement; d: radiograph of the hand at the end of the surgery

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4. Fig. 3. The result of the non-vascularized proximal phalanx transplantation of toe IV into the region of the proximal phalanx of the finger III in case of brachydactyly: a: image of the hand before surgery; b: diastasis between the head of the metacarpal bone and the middle phalanx of the ray IV of the hand; c: proximal phalanx of the toe IV placed in the recipient zone; d: X-ray of the hand 2 years after surgery

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5. Fig. 4. The use of a compression-distraction apparatus to restore the linear dimensions of finger IV in a child with the consequences of hematogenous osteomyelitis of the proximal finger IV phalanx: a, b: the finger IV length was restored using the distraction method; c: diagram of soft tissue incision after removal of the distraction apparatus; d: the defect of the proximal phalanx of the finger IV was replaced with the proximal phalanx of toe IV

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6. Fig. 5. The final result of the finger IV reconstruction; the proximal phalanx of the finger IV was restored: a, b: image and radiograph of the hand after surgery; c, d: image and radiograph of the foot postoperatively

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7. Fig. 6. Image and radiographs of the right hand of child M., 2 years old, with congenital brachydactyly of finger I and ectrodactyly of fingers II–V: a, b: image and radiograph of the hand preoperatively; c, d: image and radiograph of the hand 4 years postoperatively

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8. Fig. 7. Intraoperative radiographs of the hand and foot of patient M., 2 years old: transplantation of the proximal phalanx of toe IV into the position of the proximal phalanx of the finger I

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Copyright (c) 2022 Shvedovchenko I.V., Koltsov A.A., Matveev P.A., Komarova A.V.

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