One-stage reconstruction of 4 fingers in children using microsurgical autotransplantation of foot tissue complexes

BACKGROUND: Toes to hand transfer is still the most promising and relevant method for restoring fingers that are missing from birth or after injury. In cases where it is necessary to restore 2 or more digits, simultaneous transplantation of tissue complexes from both feet, including one or two toes, is possible and necessary. Thus, during one operation it is possible to restore a maximum of 4 fingers. Such operations, according to literature, are performed extremely rarely, because are very considerable and time-consuming. AIMS: To present the results of experience of simultaneous microsurgical autotransplantation of 4 toes to hand in children with congenital and acquired pathologies. MATERIALS AND METHODS: Using clinical, radiological, and biomechanical methods, we assessed results of 9 patient’s treatment with congenital and acquired deformities of upper limb, who underwent simultaneous microsurgical autotransplantation of 2 tissue complexes from each foot, including 2nd-3rd toes. Indications for performing this method of microsurgical reconstruction in children with absence of 4 (or all five) fingers have been determined. The results, postoperative complications, and condition of donor and recipient zones were analyzed. RESULTS: To date, 914 such operations have been performed in children. In 9 cases, 4 toes were simultaneously transplanted (two from each foot). The average age of patients was 4.2 years. 2 children had congenital malformations of hand and 7 had consequences of trauma. In 8 cases, the 2nd to 5th fingers were restored, and in one case, the 1st to 4th fingers were restored. Complications associated with impaired blood circulation in the grafts were observed in 22%, but they were temporary. All transplanted grafts survived. All patients required continued surgical treatment after toes transfer to improve their appearance and function. Biomechanical examination methods showed complete restoration of their function on average 4 months (± 1 month) after surgery. CONCLUSIONS: This study showed possibility and effectiveness of multiply toes to hand transfer in children with both congenital and acquired hand pathologies when it is necessary to restore 4 fingers. Simultaneous microsurgical transplantation of toes ensures the restoration of good appearance of the hand and its functionality.