Free vascularized joint transfer from toe to hand

Hand is one of the most complicated structures in the human body. It plays a very imported role in human communication and interaction with the environment. Therefore it is the most commonly injured organ of the body. Involvement of the small joint of the hand in these injuries is relatively rare. But the recovery period and treatment of the small joint traumas are pretty challenging. Even with the ideal treatment they may heal with sequelae frequently. These sequelae often result in global hand dysfunction, impairment of daily life activities and disabilities in work-related activities. Throughout history, reconstruction of proximal interphalangeal (PIP) joints, which are dysfunctional, deformed, painful, stiff, contracted and lacking motion has been a challenging entity for plastic and reconstructive surgeons. Arthrodesis as one of the reconstructive options has the disadvantage of immobile reconstruction. Because of the thin soft tissue coverage and delicate anatomy of the region, the mobile alternative joint arthroplasty and implants frequently bring with potential complications such as infection, implant loosening, joint contractures and dislocation. Free vascularized transfer of the PIP joint from second toe is one of major alternatives for finger joint reconstruction, especially for young and active patients. It has sufficient stability and range of motion, lacks long-term disadvantages of joint implants thereby allows autogenous reconstruction with a composite flap. Other advantages are growth potential due to transfer of epiphyseal growth plates in children and minimal donor area morbidity. In our study we analyzed 7 cases of free vascularized PIP joint transfer. The measurements for active and passive range of motion (ROM), grip and pinch strength has been done preoperatively and 1-year postoperatively. The functional change in daily life quality and work-related activities were evaluated with DASH questionnaire. Comparing preoperative and postoperative mean values active ROM and passive ROM increased from 3,6 to 24,1 degrees and from 11,9 to 31,6 degrees, respectively. Mean grip and pinch strength increased from 52,1 lbs. to 58,6 lbs. and from 5,1 lbs. to 5,9 lbs., respectively. Mean preoperative and postoperative DASH-scores were 41,3 and 30,3. These declining average DASH-scores are interpreted as improved functional status. With these results it has been shown that free vascularized joint transfer improves patients' daily life quality and work-related activities via providing a functional joint if performed with appropriate indications, careful planning and meticulous surgical execution.