TOE HAND TRANSFER IN CONGENITAL-MALFORMAT ION OF THE HAND

Toe transfer is a well established procedure for thumb and finger reco nstruction after mutilation. The indications in congenital malformatio ns are a mater of controversy. Out of a personal series of 209 patient s, 42 were children presenting a congenital malformation. Thirty six, with 46 transfers were available for review. There is only one failure at the biginning of our experience. The main indication was absence o f pinch either due to absence of thumb (like in congenital band syndro me or some extreme cases of ulnar club hand or cleft hand) or absence of long finger (like in symbrachydactyly monodactylous type) or lack o f both thumb and finger (like in peromelic type of symbrachydactyly). In this last type, we have been disappointed by the functional result of the distal implantation of two second toes taken from both feet; we have proposed a ''stub'' operation consisting in a second toe transfe r on the anterior aspect of the radial epiphysis to take advantage of the mobility of the wrist and the availability of plenty tendon transf er (in this proximal situation. When planing to ''built'' an absent pi ncer, an early age is mandatory for operation (mean 12 months), to ens ure a good cortical integration. A less frequent indication is a parti al toe transfer with a vascularized epiphysis to provide growth and mo bility in some cases of thumb hypoplasia (like in symbrachydactyly or Blauth and Manske type III b). Results are difficult to assess due to the early operation but if the mobility has been disappointing (mean 3 2 degrees), sensibility (mean 2PD 5nm) and growth were excellent.