63. TWISTED TWO TOES TRANSFER FOR RECONSTRUCTION OF THUMB AMPUTATION IN CHILDREN: TWO CASES

Abstract

Purpose of the study: Amputation of the thumb is a serious hand injury producing a major functional and aesthetic handicap. In 1980, Foucher proposed a twisted two toes transfer associating elements harvested from the first and second toes on the same pedicle for the reconstruction of an ‘articulated’ thumb with preserved potential for growth.

Material and method: Since 2002, two children aged 10 and 14 years underwent this procedure. The thumb amputation was trans MP for one and at the base of P1 for the second. The transfer associated a sheath of skin from the hallux to wrap around the skeleton of the second toe which was harvested as need to the IP or the MP. The aesthetic, functional (400 point scale), and radiological outcomes were assessed.

Results: Follow-up was 5 years and 2.5 years. The aesthetic result was comparable to wrap-around transfers. Regarding the functional outcome, the overall hand function was scored 86% and 72% of normal, mobility 77% and 72%, and force 75% and 79%. One patient had persistent deficient active flexion of the interphalangeal joint because of flexor adherences. Despite the reconstruction of the “two-joint” thumb, fine movements were difficult. Sensitivity was noted normal: Weber 5 and 8 mm. Healing of the donor site was rapid and the sequelae discrete. The first ray was preserved. Gait was not hindered. In one patient, radiographs showed skeleton growth.

Discussion: Transfer of the second toe provides a potential for growth, but the aspect is less than satisfactory and the functional results often disappointing. There are no indications except for very proximal amputations. Total transfer of the great toe would also provide potential for growth, but the voluminous aspect and the very important sequelae for the foot rule out this option.

Conclusion: For growing children, the twisted two toe transfer for amputations of the metacarpophalangeal region is the only available technique allowing nearly normal reconstruction of the thumb in terms of mobility, force, sensitivity, appearance, and growth. The foot reconstruction is simple, aesthetic and functional. The complexity of the procedure may nevertheless limit is use.