From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University.
Plast Reconstr Surg. 2019 Apr;143(4):1122-1132. doi: 10.1097/PRS.0000000000005422.
Patient-reported outcome measures are an important metric in evaluating treatment efficacy of reconstructive surgery. Toe-to-hand transfer can restore vital prehensile function; however, this surgery is complex, extensive rehabilitation is required, and there are concerns about donor-site morbidity. This study longitudinally explores the benefits of this procedure, from the patient's perspective, using patient-reported outcome measures.
Twenty-three patients who underwent free toe-to-hand transfers from 2012 to 2015 were evaluated preoperatively and postoperatively using the following validated questionnaires: the Michigan Hand Outcomes Questionnaire, the 36-Item Short-Form Health Survey, and the Lower Limb Outcomes Questionnaire. Subgroup analysis was performed between dominant and nondominant reconstructed hands.
Mechanism of injury was crush in 83 percent; the remainder sustained cutting, avulsion, and burn injuries. Thirty-four toes were transferred: nine great toes, 20 second toes, and five third toes. Michigan Hand Outcomes Questionnaire results showed significant improvement in overall activities of daily living, work, aesthetics, and patient satisfaction (p < 0.05). The results of the 36-Item Short-Form Health Survey showed significant improvements in physical and emotional roles (p < 0.05). The Lower Limb Outcomes Questionnaire showed no deterioration of foot function (p = 0.55). Subgroup analysis showed significant improvement in patient-reported outcome measures for patients undergoing dominant hand reconstruction but no difference between thumb reconstruction and finger-only reconstruction.
Patient-reported outcome measures demonstrate the significant utility of toe-to-hand transfer procedures in both functional and psychosocial domains in that there are relatively greater benefits in reconstructing the dominant hand, and that donor-site morbidity is well tolerated.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
患者报告的结局测量是评估重建手术治疗效果的重要指标。足趾到手的移植可以恢复重要的抓握功能；然而，这种手术复杂，需要广泛的康复，并且存在对供体部位发病率的担忧。本研究从患者的角度，使用患者报告的结局测量，纵向探讨了这种手术的益处。
2012 年至 2015 年间，对 23 例接受游离足趾到手移植的患者进行了术前和术后评估，使用以下经过验证的问卷：密歇根手功能问卷、36 项简短健康调查和下肢结局问卷。对优势和非优势重建手进行了亚组分析。
83%的患者受伤机制为挤压伤；其余患者为切割伤、撕脱伤和烧伤。共转移 34 个脚趾：9 个大脚趾、20 个第二脚趾和 5 个第三脚趾。密歇根手功能问卷结果显示，日常生活活动、工作、美观和患者满意度总体活动有显著改善（p<0.05）。36 项简短健康调查结果显示，身体和情绪角色有显著改善（p<0.05）。下肢结局问卷显示足部功能无恶化（p=0.55）。亚组分析显示，优势手重建患者的患者报告结局测量有显著改善，但拇指重建与仅手指重建之间无差异。
患者报告的结局测量表明，足趾到手的移植程序在功能和社会心理领域具有显著的效用，因为重建优势手的益处相对更大，并且供体部位发病率得到很好的耐受。
临床问题/证据水平：治疗，IV。
