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Vascularized Toe and Non-Vascularized Toe Phalangeal Transfer for Reconstruction of Congenital Absence of Digits or Thumb: A Systematic Review of the Literature
Abigail Meyers, BS; Bahar Bassiri Gharb, MD, PhD; Antonio Rampazzo, MD, PhD
Cleveland Clinic Department of Plastic Surgery
2021-02-01
Presenter: Abigail Meyers
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. A majority of the study design and entirety of data collection, analysis, and writing in preparation of the abstract was carried out by the first author.
Director Name: Antonio Rampazzo
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose:
Non-vascularized toe phalanx transplantation was first described to lengthen or reconstruct hands, though criticized for high rates of avascular necrosis. More recently, vascularized transfer has improved graft survival, with adequate perfusion enabling increased growth. The aim of this study was to compare the techniques.
Methods:
A systematic review was conducted according to PRISMA guidelines. Studies containing indications, surgical technique, and outcomes for patients with congenital absence or deficiency of digits or thumb treated with toe-to-hand transfer were included. Statistical significance of 95% CIs was determined using a chi-square test.
Results:
Forty studies published between 1978-2020 were included. Three hundred nineteen patients (59.7%) had vascularized, and 214 (40.1%) non-vascularized transfers. The mean age for vascularized transfers was 2.5 years and for non-vascularized, 3.1 years.
Symbrachydactyly was the most common indication for both (46.3% each). The most commonly transplanted vascularized toe was the second (91.5%), while the fourth toe was most commonly used in the non-vascularized group (61.9%).
The follow-up for the vascularized group was 4 months to 11 years and 6 months to 35 years in the non-vascularized group. Vascularized toes showed better stability, healing, range of motion, and growth. In the vascularized group, there was a higher success rate of 98.6% (95% CI 97.4%-99.7%). The non-vascularized group had a success rate of 86.8% (95% CI 83.6%-90), (p<0.05).
Conclusions:
Both toe transfer techniques are good options for reconstruction of congenital absence or deficiency of digits or thumb. Our study found a higher success rate in vascularized compared to non-vascularized transfers.
