Functional Improvement with Free Vascularized Toe-to-hand Proximal Interphalangeal (PIP) Joint Transfer

Background: Reconstruction of small joints of fingers is still challenging in handsurgery. Implant arthroplasty and arthrodesis have some limitations in the reconstruction of small finger joints. Free vascularized PIP joint transfer from second toeto finger is a promising autogenous reconstructive alternative.Methods: In this prospective study, 7 cases of free vascularized PIP joint transferwere analyzed. 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 was evaluatedwith Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.Results: Mean follow-up period was 20.3 months (12–25). Preoperative mean active and passive ROM values were 3.6º (0–14º) and 11.9º (0–29º), respectively.Postoperative 1-year measurements revealed a mean active ROM of 24.1º and amean passive ROM of 31.6º. Mean grip and pinch strength increased from 52.1 to58.6 lbs and from 5.1 to 5.9 lbs, respectively. Mean preoperative and postoperativeDASH-scores were 41.3 and 30.3.Conclusion: The improvement in ROM, increasing grip strength, and declining DASHscores in our study support that free vascularized joint transfer improves patients’ dailylife quality and work-related activities via providing a functional joint if performed withappropriate indications, careful planning, and meticulous surgical execution. Free vascularized joint transfer provides an autogenous, painless, mobile, and stable joint. Italso has the advantages of composite tissue reconstruction and lacks the disadvantagesof arthrodesis and synthetic joint implants. (Plast Reconstr Surg Glob Open 2018;6:e1775;doi: 10.1097/GOX.0000000000001775; Published online 9 July 2018.)

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