Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, USA.
Department of Orthopedic Surgery and Division of Plastic Surgery, University of California Los Angeles, USA.
J Burn Care Res. 2022 Mar 23;43(2):440-444. doi: 10.1093/jbcr/irab101.
Children are one of the most vulnerable populations to burns, and hands are frequently burned anatomical structures. Restoring function in a severely burned pediatric hand is challenging. We present our experience with pediatric toe-to-thumb transfers for burn reconstruction. A retrospective review was conducted of all pediatric toe-to-thumb transfer patients between 2009 and 2014. Children younger than the age of 18 who underwent secondary reconstruction after electrical or thermal burn injuries with at least a 5-year follow-up were included. Functional outcomes were measured with the modified Kapandji score. Complications of the reconstructed hand as well as the donor foot were recorded. Four children with 10 toe-to-hand transfers (four great toes, two second toes, and two combined second-third toes) met the inclusion criteria. The average follow-up length was 104 months (range 60-144 months). Two children sustained thermal burn injuries and two sustained electrical burn injuries. Three children achieved opposition of the reconstructed toe-to-thumb transfer to the small finger (Kapandji score 5), and one child achieved opposition of the reconstructed toe-to-thumb transfer to the proximal phalanx of the middle finger, the only remaining finger (Kapandji score 3). No donor foot morbidities were noted postoperatively. Toe-to-thumb transfers should be considered the standard of care for thumb reconstruction in children with severe burn injuries of their hands to provide restoration of sensation, pinch, grasp, and opposition with minimal morbidity of the donor foot.
儿童是烧伤最易受影响的人群之一，手部是经常被烧伤的解剖结构。恢复严重烧伤儿童手部的功能是具有挑战性的。我们介绍了我们在儿科脚趾到拇指转移用于烧伤重建方面的经验。对 2009 年至 2014 年间所有接受过小儿脚趾到拇指转移的患者进行了回顾性研究。年龄在 18 岁以下的儿童，在因电或热烧伤接受二期重建后，随访时间至少为 5 年，符合纳入标准。采用改良 Kapandji 评分评估功能结果。记录重建手和供足的并发症。符合纳入标准的有 4 名儿童，共进行了 10 例脚趾到拇指转移（4 个大脚趾，2 个第二脚趾，2 个第二和第三脚趾联合）。平均随访时间为 104 个月（60-144 个月）。2 例患儿为热烧伤，2 例患儿为电烧伤。3 例患儿重建的脚趾到拇指转移达到对小指的对掌（Kapandji 评分为 5），1 例患儿重建的脚趾到拇指转移达到对中指近节指骨，即唯一剩余的手指（Kapandji 评分为 3）。术后未发现供足的并发症。对于手部严重烧伤的儿童，脚趾到拇指转移应被视为拇指重建的标准治疗方法，以提供感觉、捏、抓握和对掌功能的恢复，同时最小化供足的发病率。
