Lin Yu-Te, Loh Charles Yuen Yung
Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Keelung City, Taiwan.
Department of Plastic Surgery, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, UK.
Plast Reconstr Surg Glob Open. 2021 Jan 26;9(1):e3338. doi: 10.1097/GOX.0000000000003338. eCollection 2021 Jan.
Free vascularized joint transfers (VJT) are indicated for reconstruction of a composite defect of the finger joints. When the bone defect involves the proximal interphalangeal joint (PIPJ) and the full length of the middle phalanx, using the toe PIPJ with a shorter middle phalanx to reconstruct such a defect will be difficult. In this article, we describe an unusual application to repair the composite defect with a reversed inset of the toe PIPJ, where the proximal phalanx of the toe is placed distally and vice versa.
We describe a new technique to repair the composite defect with a reversed inset of the toe PIPJ. A 33-year-old woman sustained a crush injury to the left, middle, and ring finger, having fallen off her moped in a road traffic incident. A vascularized PIPJ from the second toe along with a hemipulp (1 × 4 cm) from the great toe transfer was performed with a reverse inset.
With intensive physiotherapy and surgical tenolysis, a range of motion of 20-80 degrees at the new PIPJ was achievable. The joint motion was stable, and the radiograms of the finger demonstrated no visible joint degeneration. She reported the use of the finger, which improved overall hand function.
Reverse inset of toe PIPJs is possible in simultaneous reconstruction of damaged finger PIPJs and building up of bony length distally.
游离带血管蒂关节移植（VJT）适用于手指关节复合缺损的重建。当骨缺损累及近端指间关节（PIPJ）和中节指骨全长时，使用中节指骨较短的趾间关节PIPJ来重建此类缺损会很困难。在本文中，我们描述了一种不寻常的应用，即通过将趾间关节PIPJ反向植入来修复复合缺损，其中趾的近节指骨置于远端，反之亦然。
我们描述了一种通过将趾间关节PIPJ反向植入来修复复合缺损的新技术。一名33岁女性在道路交通事故中从助力车上摔下，导致左手示指、中指和环指挤压伤。采用反向植入方式进行了第二趾带血管蒂的PIPJ以及拇趾半侧甲皮瓣（1×4 cm）的移植。
通过强化物理治疗和手术松解，新的PIPJ可实现20 - 80度的活动范围。关节活动稳定，手指X线片显示无明显关节退变。她报告手指可使用，这改善了手部整体功能。
在同时重建受损手指PIPJ和增加远端骨长度时，趾间关节PIPJ反向植入是可行的。
