title: Creation of a four-joint-digit after second toe to digit transplantation: restoration of form and function.
abstract: The authors describe the non-orthotopic insertion of an Ascension two-piece pyrocarbon proximal interphalangeal joint at the osteosynthesis level of bilateral toe-to-digit transplantations in an attempt to restore both anatomic length and composite fist formation after traumatic multidigit loss. The non-orthotopic joints provided an additional 30 and 35 degrees of stable flexion to the reconstructed index and longs digits enabling the patient to form a composite fist. There was no evidence of joint instability or loosening. Total active motion was 240 and 235 degrees at the index and long fingers, respectively. Creation of two four joint fingers by the addition of non-orthotopic joints in toe-to-digit reconstructions successfully restored form and function after multidigit loss.
authors.affiliation: Buncke Clinic, Plastic and Reconstructive Surgery, California Pacific Medical Center, San Francisco, CA 94114, USA. darrellbrooks@usa.net
authors.forename: Darrell
authors.initials: D
authors.lastname: Brooks
authors.forename: Rudolf F
authors.initials: RF
authors.lastname: Buntic
authors.forename: Ramon
authors.initials: R
authors.lastname: De Jesus
mesh_terms: D000328:Adult; D019643:Arthroplasty, Replacement / Q000379:methods; D003131:Combined Modality Therapy; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery*; D005384:Finger Joint / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007595:Joint Prosthesis; D008297:Male; D008662:Metacarpophalangeal Joint / Q000293:injuries / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D012086:Reoperation; D018570:Risk Assessment; D050277:Toe Phalanges / Q000098:blood supply / Q000637:transplantation*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology