Reconstruction of phalangeal articulations of the hand with vascularised phalangeal articulations of foot.
Since arthroplasty, prosthetic replacement and non-vascularised articulation autografting do not normally produce very satisfactory results for ankylosis of metacarpophalangeal and interphalangeal joints, the authors performed reconstruction of phalangeal articulations of the hand using vascularised phalangeal articulations of the foot in 11 patients with ankylosis of the metacarpophalangeal and interphalangeal joints of hand due by trauma. Procedures included reconstruction of 9 hand metacarpophalangeal joints with vascularised grafting of pedal metatarsophalangeal joints in six patients, reconstruction of the hand metacarpophalangeal joints with grafting of vascularised proximal interphalangeal joints of foot in two patients and reconstruction of the hand proximal interphalangeal joints with grafting of vascularised proximal interphalangeal joints of foot in three patients. Early functional exercise was encouraged in all cases post-operatively. Follow-up ranged from 3 to 10 years and revealed that 9 cases had normal appearance and length of recipient area, 1 had slightly clumsy dorsal skin in the hand and 1 had slight dorsal angulation of a metacarpal bone. Recovery of joint range of motion was satisfactory. Radiographic, gross and sensation examinations also showed good operative outcomes. The authors believe that vascularised pedal metatarsophalangeal joints, with a rich blood supply, can be grafted to effectively reconstruct the finger joints with good function. A low rate of degeneration results because pedal and hand metatarsophalangeal joints are similar in anatomy and physiological function.
Pei
Guo-xian
GX
Department of Orthopaedic Trauma, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. zhangzj6@yahoo.com
Ren
Gao-hong
GH
Ren
Yi-jun
YJ
Wei
Kuan-hai
KH
D000293:Adolescent; D000844:Ankylosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005384:Finger Joint / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000150:complications; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000098:blood supply / Q000601:surgery*; D008866:Microsurgery / Q000379:methods; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult