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Simultaneous reconstruction of extensor mechanism in the free transfer of vascularized proximal interphalangeal joint.
MedLine Citation:
PMID:  23423230     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
From a recent systemic review, vascularized toe proximal interphalangeal joint (PIPJ) transfer achieved an average arc of motion (AOM) of merely 37 degrees for finger PIPJ reconstruction. Despite the technical refinement over the past 3 decades, the resulting active motion of the reconstructed joint remains unpredictable and often fraught with extension lag. The technique for vascularized toe PIPJ transfer at our institute has evolved over the years to its current state, with simultaneous extensor mechanism reconstruction being a major component. During the transfer, the quality of extensor tendons on the recipient finger and donor toe are carefully evaluated. If the central slip of finger extensor is destroyed but the quality of lateral bands is adequate, centralization of lateral bands overlying the transferred PIPJ is performed. If there is acceptable central slip remnant at the proximal phalanx level, modified Stack procedure is performed for central slip reconstruction while leaving the lateral bands in continuity. If both lateral bands are poor, modified Stack procedure is performed unless the central tendon of the toe is strong enough to extend the PIPJ. From November 2008 to October 2010, 7 joints were transferred with this modified technique. The average follow-up was 18.2 months. The average active AOM of the transferred PIPJ was 56.4 degrees. The average extension lag of the toe PIPJ was 10.7 and 16.4 degrees before and after the transfer, respectively. Simultaneous reconstruction of extensor mechanism decreases the extension lag without sacrificing AOM of the transferred PIPJ.
Authors:
Yu-Te Lin; Dennis S Kao; Derrick C Wan; Shwu-Huei Lien; Chih-Hung Lin; Fu-Chan Wei
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Techniques in hand & upper extremity surgery     Volume:  17     ISSN:  1531-6572     ISO Abbreviation:  Tech Hand Up Extrem Surg     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9704676     Medline TA:  Tech Hand Up Extrem Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  20-4     Citation Subset:  IM    
Affiliation:
*Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine ‡Department of Plastic and Reconstructive Surgery, Rehabilitation Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan †Plastic and Reconstructive Surgery, Stanford Hospital and Clinics, Stanford University, Palo Alto, CA.
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