Second toe extensor digitorum brevis provides a simultaneous abductorplasty to free vascularized metatarsophalangeal joint transfer for posttraumatic thumb composite metacarpophalangeal joint defect.
BACKGROUND
For functional reconstruction of a thumb metacarpophalangeal joint defect with loss of opposition, we need to address both joint mobility and thumb opposition. Free vascularized second toe joint transplantation provides joint replacement, as well as extensor and flexor tendons for apprehensile thumb restoration. Furthermore, the extensor digitorum brevis (EDB) allows a simultaneous abductorplasty for the reconstruction of traumatized abductor pollicis brevis.


METHODS
Seven patients underwent one-stage vascularized second toe metatarsophalangeal joint transfers to thumb metacarpophalangeal joints with the aim of reconstructing posttraumatic composite soft tissue, joints, and extrinsics or intrinsics tendon loss or both. The EDB was used for restoring abduction function, with the method of repairing to either remaining abductor pollicis brevis or palmaris longus tendon.


RESULTS
All seven toe joints survived. Tenolysis and web-space contracture release was performed in three patients. One patient underwent corrective osteotomy for radial deviation. Patients were followed up for an average of 47 months. The average active arc of motion of the joints was 27.10 (range, 0-400). Angle of first ray separation or circumduction presented 63.3% or 55.3% compared with the uninjured side. Opposition of the thumb was assessed with the scoring system described by Kapandji, and the average score was 6.85.


CONCLUSIONS
Simultaneous second toe EDB abductorplasty and vascularized second toe metatarsophalangeal joint transfer can provide a one-stage thumb MPJ composite defect reconstruction with apprehensile function.
Department of Plastic Reconstructive Surgery, Trauma Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. chihhung@cgmh.org.tw
Chih-Hung
CH
Lin
Pei-Linh
PL
Tang
Cheng-Hung
CH
Lin
D000328:Adult; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000098:blood supply*; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D013709:Tendon Transfer / Q000379:methods; D013710:Tendons / Q000637:transplantation*; D013933:Thumb / Q000293:injuries* / Q000601:surgery*; D014033:Toe Joint / Q000601:surgery / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult