The "stub" operation--modification of the Furnas and Vilkki technique in traumatic and congenital carpal hand reconstruction.
A technique is described for reconstruction of a pincer, by a second toe transfer, in traumatic and congenital deformities, leaving only the wrist. An anterior transfer on the radius allows the wrist mobility to compensate for the limited range of mobility of the second toe. Proximal situation of the toe gives the possibility of having plenty of tendons to balance the transfer. From 1987 to 1992, 8 such operations were performed, 2 in traumatic amputations and 6 in cases of congenital anomalies. The mean age of the congenital patients was 13 months (range, 11 to 21 months) and the 2 traumatic patients were 17 and 20 years of age. In one of the traumatic cases, a sensibility of 11 mm was obtained at 22 months and the wrist mobility in flexion was 55 degrees. The overall mobility of the toe was 35 degrees. In the second traumatic case, the two-point discrimination was 11 mm on the second toe and 10 mm on the great toe pulp. The wrist mobility remains limited (around 20 degrees) but distant contact is possible. In most of the congenital patients the mean mobility reached an average of 40 degrees at the toe level whereas the wrist mobility was an average of 52 degrees, an improvement over peroperative values. In all the 8 patients, the epiphyses remain open.
Foucher
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Emergency Hand Unit, Strasbourg, France.
D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D001753:Blast Injuries / Q000601:surgery; D002348:Carpal Bones / Q000002:abnormalities* / Q000293:injuries*; D002648:Child; D003444:Crush Syndrome / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006228:Hand Deformities, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008465:Mechanoreceptors / Q000503:physiopathology; D008866:Microsurgery / Q000379:methods*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D013709:Tendon Transfer / Q000379:methods; D014034:Toes / Q000637:transplantation*; D014954:Wrist Injuries / Q000601:surgery*