title: A Novel Preoperative Planning Technique Using a Combination of CT Angiography and Three-Dimensional Printing for Complex Toe-to-Hand Reconstruction.
abstract: BACKGROUND
  Microsurgical toe-to-hand transplantation is a reasonable salvage procedure after failed replantation, though no consensus exists on proper donor toe length for restoration of hand function and optimal donor flap needed for recipient site healing. The purpose of this study was to introduce a novel technique for preoperative planning in complicated toe-to-hand reconstruction and to assess feasibility in four cases.
  
  
  METHODS
  Computed tomography (CT) angiography was used to map donor site vasculature, whereas CT data were used to create three-dimensional (3D) soft tissue and skeletal models for injured and uninjured hands. Based on the reformatted model (mirror of uninjured hand), soft tissue and finger skeleton models were generated using a 3D printer. An adhesive plaster model was placed on the donor site to determine osteotomy level and incision markings. The skeletal model was used to determine the length of the donor foot resection. Four complex amputation cases were included to illustrate clinical feasibility and early functional and cosmetic outcomes.
  
  
  RESULTS
  In all four cases, thumb and fingers were reconstructed successfully and all flaps survived. No arterial or venous thrombosis or major donor morbidity were observed. Functional and cosmetic outcomes were satisfactory with similarly satisfactory static two-point discrimination, key pinch and grip strength, and Michigan Hand Outcomes Questionnaire scores.
  
  
  CONCLUSIONS
  This novel microsurgical toe-to-hand reconstruction methodology, as introduced in this study, showed promising functional and cosmetic outcomes. Application of this technique in complex hand injuries has the potential to increase surgical efficiency, minimize procedural morbidity, and improve reproducibility.
authors.affiliation: Department of Orthopaedics, Guigang City People's Hospital, Guigang, People's Republic of China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Tan
authors.affiliation: Department of Orthopaedics, Guigang City People's Hospital, Guigang, People's Republic of China.
authors.forename: Keqin
authors.initials: K
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, Guigang City People's Hospital, Guigang, People's Republic of China.
authors.forename: Pingou
authors.initials: P
authors.lastname: Wei
authors.affiliation: Institute of Clinical Anatomy, Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Dimitriou
authors.affiliation: Department of Orthopaedics, Guigang City People's Hospital, Guigang, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.affiliation: Institute of Clinical Anatomy, Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Orthopaedics, Guigang City People's Hospital, Guigang, People's Republic of China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Luo
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic; D000792:Angiography / Q000379:methods*; D002983:Clinical Competence; D017076:Computer-Aided Design; D005383:Finger Injuries / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008866:Microsurgery / Q000379:methods*; D066330:Printing, Three-Dimensional; D019651:Plastic Surgery Procedures / Q000379:methods*; D014034:Toes / Q000637:transplantation*; D014057:Tomography, X-Ray Computed; D055815:Young Adult