Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, 5, Fu-Hsing Street, Kuei-Shan, Taoyuan 333, Taiwan.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, 5, Fu-Hsing Street, Kuei-Shan, Taoyuan 333, Taiwan.
J Plast Reconstr Aesthet Surg. 2014 Jan;67(1):56-62. doi: 10.1016/j.bjps.2013.09.010. Epub 2013 Sep 15.
Vascularised joint transfer (VJT) from the toe proximal interphalangeal joint (PIPJ) has been criticised for providing a limited range of motion (ROM) and significant extensor lag in reconstructed digits. The original technique includes the dorsal skin of toe PIPJ as a marker of joint viability, while a modified technique uses the skin flap of the great toe and the dorsal foot. This systematic review aimed to assess vascularised toe-to-finger PIPJ transfers with respect to functional outcomes, and in particular, whether a modified skin paddle design can improve extensor lag.
A MEDLINE search was performed. Studies were included if they present five or more vascularised toe-to-finger PIPJ transfers for posttraumatic reconstruction, and with the functional outcome data available.
Seven studies including 92 VJTs met the inclusion criteria. The overall survival rate was 93.5%. Among the successful 86 VJTs, mean single-joint ROM was 37.4 ± 21.1°, with a mean extension lag of 31.8 ± 18.8° and a mean flexion of 69.2 ± 22.8°. The traditional group with the skin paddle taken from the dorsum of the toe PIPJ had a statistically significantly greater extensor lag than the modified group with the skin paddle harvested from the great toe and dorsal foot (37.8° vs. 17.1°, p < 0.001). The secondary variable of interest was age of the patient at time of transfer (children vs. adults). There was no significant difference in ROM between younger (≤16 years) and older patients (>16 years).
This systematic review suggests that extensor lag may be improved by using the modified skin paddle design by harvesting it from the great toe and the dorsal foot. This effect may be mediated by the preservation of the native extensor tendon apparatus in the finger.
从脚趾近节指间关节 (PIPJ) 转移的带血管关节 (VJT) 因重建手指的运动范围 (ROM) 有限和明显的伸肌滞后而受到批评。原始技术包括脚趾 PIPJ 的背侧皮肤作为关节存活的标志物，而改良技术则使用大脚趾和足背的皮瓣。本系统评价旨在评估带血管的脚趾到手指 PIPJ 转移的功能结果，特别是改良皮瓣设计是否可以改善伸肌滞后。
进行了 MEDLINE 搜索。如果有五项或更多的带血管的脚趾到手指 PIPJ 转移用于创伤后重建，并且可以获得功能结果数据，则将研究纳入。
符合纳入标准的有 7 项研究共 92 例 VJT。总的存活率为 93.5%。在 86 例成功的 VJT 中，平均单关节 ROM 为 37.4 ± 21.1°，平均伸肌滞后为 31.8 ± 18.8°，平均屈曲为 69.2 ± 22.8°。从脚趾 PIPJ 的背侧取皮瓣的传统组的伸肌滞后明显大于从大脚趾和足背取皮瓣的改良组（37.8° vs. 17.1°，p < 0.001）。感兴趣的次要变量是转移时患者的年龄（儿童与成人）。在年轻（≤16 岁）和年长患者（>16 岁）之间，ROM 没有显著差异。
本系统评价表明，通过从大脚趾和足背取改良皮瓣设计，伸肌滞后可能会得到改善。这种效果可能是通过保留手指的固有伸肌腱装置来介导的。
