ReviewVascularised toe proximal interphalangeal joint transfer in posttraumatic finger joint reconstruction: The effect of skin paddle design on extensor lag☆
Section snippets
Literature search
A literature search was performed with the MEDLINE database. Two categorical searches were conducted using the medical subject heading terms: (1) “fingers/surgery”, “finger joint/surgery”, OR “finger injuries”; and (2) “toe joint/transplantation”, “joints/transplantation”, OR “toes/transplantation” and were combined using “AND”. A total of 247 citations were retrieved in October 2012. Relevant titles and abstracts of identified citations were assessed and the full text of all potentially
Study retrieval and study characteristics
Seven studies representing 92 vascularised toe-to-finger PIPJ transfers met the inclusion criteria, including six retrospective cases series and one cohort study (Figure 1).4, 7, 8, 9, 10, 11, 12 Most studies included different indications. Four studies reported anatomical prerequisites for the affected finger PIPJ. Ellis et al.,4 Chen et al.9 and Dautel et al.12 required good function of tendons. Kimori et al. included injured joints, in which the damage involved mainly the dorsal surface and
Addressing the problem of extensor lag in VJT
This systematic review showed that an overall ROM after vascularised toe-to-finger PIPJ transfer ranged from 31.8 to 69.2°. Due to the anatomic disparity between fingers and toes, the normal ROM of the toe PIPJ of all ages was narrower, with an average of 15–70°, resulting in an inherent shortage in ROM following VJT.13 Transferred toe PIPI joints can reach the maximal flexion limits of their native position, with an average of 69.2°. However, extensor lag becomes more pronounced after
Conclusion
This systematic review showed that vascularised toe-to-finger PIPJ transfer could provide acceptable functional ROM for posttraumatic reconstruction. In addition, we hope to provide surgeons with a guide to improve the functional ROM of VJT and broaden its clinical applications. This is the first study that critically compares the outcomes for different surgical techniques in vascularised toe-to-finger PIPJ transfer. Based on the results from this systematic review, we found that harvesting the
Conflict of interest statement
The authors have no financial interest to declare in relation to the content of this article.
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Presented at the Scientific Meeting of American Society for Reconstructive Microsurgery, in Las Vegas, NV, USA, 14–17 January 2012.