Shandong Provincial Hospital, Shandong University, Jinan, China.
Department of Hand & Foot Surgery and Reconstructive Microsurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Orthop Surg. 2024 Sep;16(9):2289-2294. doi: 10.1111/os.14229. Epub 2024 Sep 5.
Partial great toe transfer is widely used in finger reconstruction. Although satisfactory results have been reported at the recipient's hand, the donor foot still presents with many problems due to the large amount of tissues harvested. In this study, the Ilizarov technique was utilized to enlarge the great toe in order to minimize the amount of tissue sacrificed of the donor foot. In this retrospective study, 23 patients (30 toes) underwent transverse distraction of the great toe for finger reconstruction from September 2020 to December 2022. The width of the contralateral normal finger was set as the objective width gained of distraction. At the last follow-up, the changes of bone, toenail, plantar skin, vessel, and nerve of the great toe were measured, and postoperative complications were assessed. The time for active distraction was 46.1 ± 8.3 days, with a widening rate of 0.41 ± 0.08 mm/day. Counting in the time for latency and consolidation, the time of treatment with external fixation was 84 ± 11.9 days. At the last follow-up, the average width of the distal phalanx of the great toe increased from 13.1 to 28.1 mm (p < 0.001). The width of the toenail increased from 15.8 to 30.3 mm (p < 0.001), and the width of the plantar pulp increased from 25.6 to 38.8 mm (p < 0.001). Computed tomography angiography (CTA) and Doppler ultrasound confirmed that the digital arteries and nerves of the great toe were intact after distraction surgery. Two patients needed revision surgery due to complications of pin loosening or premature consolidation. With the help of the Ilizarov technique, the great toe is effectively enlarged after transverse distraction. Multiple tissues of the great toe, including bone, nail, and plantar skin, are regenerated, and more tissues were preserved after toe-to-hand transfer. To the best of our knowledge, this is a novel method to enlarge the donor site for finger reconstruction.
部分大脚趾转移广泛应用于手指重建。虽然在受者手部已经取得了令人满意的效果，但由于大量组织的采集，供足仍然存在许多问题。在这项研究中，我们采用伊利扎罗夫技术来扩大大脚趾，以最小化供足牺牲的组织量。在这项回顾性研究中，2020 年 9 月至 2022 年 12 月，我们对 23 名患者（30 个脚趾）进行了大脚趾的横向牵张，以用于手指重建。对侧正常手指的宽度被设定为牵张的目标增宽宽度。在末次随访时，测量了大脚趾的骨、趾甲、足底皮肤、血管和神经的变化，并评估了术后并发症。主动牵张的时间为 46.1±8.3 天，增宽率为 0.41±0.08mm/天。加上潜伏期和固定期的时间，外固定治疗时间为 84±11.9 天。末次随访时，大脚趾远节趾骨的平均宽度从 13.1 毫米增加到 28.1 毫米（p<0.001）。趾甲的宽度从 15.8 毫米增加到 30.3 毫米（p<0.001），足底皮垫的宽度从 25.6 毫米增加到 38.8 毫米（p<0.001）。CTA 和多普勒超声证实，大脚趾的趾动脉和神经在牵张手术后完整。有 2 名患者因钉松动或过早固定而需要进行翻修手术。借助伊利扎罗夫技术，大脚趾在横向牵张后可有效增大。大脚趾的多种组织，包括骨、趾甲和足底皮肤，都得到了再生，并且在脚趾到手部转移后，保留了更多的组织。据我们所知，这是一种用于手指重建的新型增大供区的方法。
