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Outcome Measures of Microsurgical Toe Transfers for Reconstruction of Congenital and Traumatic Hand Anomalies

Kaplan, Jesse D. MD*,†; Jones, Neil F. MD*,†

Journal of Pediatric Orthopaedics: April/May 2014 - Volume 34 - Issue 3 - p 362–368
doi: 10.1097/BPO.0000000000000088
Selected Topics

Background: Outcomes data for children undergoing surgical reconstruction of their congenital hand anomalies has been used infrequently or not at all. Some surgeons even contend that children with total absence of digits or hands function perfectly well. Therefore, the purpose of this study was to evaluate and compare the functional outcomes of children who have undergone microsurgical toe-to-hand transfers for reconstruction of congenital and traumatic hand anomalies with the normal pediatric population.

Methods: A total of 10 adolescents and 15 parents of pediatric and adolescent patients who underwent microsurgical toe-to-hand transfers were assessed using the Pediatric Outcomes Data Collection Instrument (PODCI) survey. Surveys were distributed during routine clinic visits or by mail. Indication and diagnosis were analyzed in relation to the functional outcomes obtained from the survey. Scores of the toe transfer patients group were compared with the scores of the normal pediatric population as well as the effect of patient and parent reporting.

Results: Of the 3 survey groups and 6 functional dimensions, there was no statistically significant difference in function between the toe transfer children and the normal pediatric population in 13 of the 18 groups (72%). Adolescent toe transfer patients reported decreased upper extremity function and transfer/basic mobility and parents of adolescents reported decreased upper extremity function, sports/physical function, and global function. Parents significantly underestimated their adolescent children’s function in terms of sports/physical function and happiness. Scores did not significantly differ between the congenital or traumatic indications for toe-to-hand transfers.

Conclusions: Children with congenital or traumatic missing or hypoplastic digits who undergo reconstruction by microsurgical toe-to-hand transfer can achieve remarkable gains in function, sensation and ability to perform daily activities. This study confirms that a significant percentage of children undergoing reconstruction by microsurgical toe-to-hand transfers have similar functional outcomes assessments when compared with the normal pediatric population.

Level of Evidence: Level III—Therapeutic study.

*Shriners Hospital for Children—Los Angeles

University of California Irvine, Orange, CA

None of the authors received any financial support for this study.

The authors declare no conflict of interest.

Reprints: Jesse D. Kaplan, MD, Center for Hand and Upper Extremity Surgery, University of California Irvine, 101 The City Drive South, Orange, CA 92868. E-mail:

© 2014 by Lippincott Williams & Wilkins