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Functional Improvement with Free Vascularized Toe-to-hand Proximal Interphalangeal (PIP) Joint Transfer

Kuzu, İsmail Melih, MD*; Kayan, Reşit Burak, MD*; Öztürk, Kahraman, MD; Güneren, Ethem, MD*

Plastic and Reconstructive Surgery – Global Open: July 9, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001775
Latest Articles: PDF Only

Background: Reconstruction of small joints of fingers is still challenging in hand surgery. Implant arthroplasty and arthrodesis have some limitations in the reconstruction of small finger joints. Free vascularized PIP joint transfer from second toe to finger is a promising autogenous reconstructive alternative.

Methods: In this prospective study, 7 cases of free vascularized PIP joint transfer were analyzed. The measurements for active and passive range of motion (ROM), grip, and pinch strength has been done preoperatively and 1-year postoperatively. The functional change in daily life quality and work-related activities was evaluated with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results: Mean follow-up period was 20.3 months (12–25). Preoperative mean active and passive ROM values were 3.6º (0–14º) and 11.9º (0–29º), respectively. Postoperative 1-year measurements revealed a mean active ROM of 24.1º and a mean passive ROM of 31.6º. Mean grip and pinch strength increased from 52.1 to 58.6 lbs and from 5.1 to 5.9 lbs, respectively. Mean preoperative and postoperative DASH-scores were 41.3 and 30.3.

Conclusion: The improvement in ROM, increasing grip strength, and declining DASH scores in our study support that free vascularized joint transfer improves patients’ daily life quality and work-related activities via providing a functional joint if performed with appropriate indications, careful planning, and meticulous surgical execution. Free vascularized joint transfer provides an autogenous, painless, mobile, and stable joint. It also has the advantages of composite tissue reconstruction and lacks the disadvantages of arthrodesis and synthetic joint implants.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Vakif University, Istanbul, Turkey

Department of Hand Surgery, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Istanbul, Turkey.

Published online 9 July 2018.

Received for publication December 18, 2017; accepted March 13, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

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İsmail Melih Kuzu, MD, Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Vakif University, Vatan Caddesi 34093 Fatih, Istanbul, Turkey, imkuzu@gmail.com

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.