Page 74 - Microsurgery

TOE TRANSFERS

Destruction of the metacarpophalangeal or interphalangeal joints frequently results in
significant functional impairment for the patient. Reconstruction alternatives include
arthrodesis, prosthetic implants, and joint transfers. Arthrodesis and prosthetic implants are
the techniques of choice for rheumatoid arthritis management; however, in cases of
traumatic injury, a vascularized joint transfer may be considered. Although a non-
vascularized joint transfer provides a complete joint structure, it tends to degrade over time.
The advantage of a vascularized transfer lies in its ability to maintain synovial fluid
production, ensuring the nutrition and viability of hyaline cartilage.

In 1967, Buncke described a vascularized metacarpophalangeal joint transfer from the index
finger. Since then, several studies have been published on these vascularized transfers. The
indications for this type of transfer include:

1. Post-traumatic joint destruction:
Joint transfer is particularly beneficial in cases of ligamentous instability, especially
for the index finger.

2. Traumatic joint injuries in children:
Continued growth is possible due to the preservation of growth cartilage.

3. Complex injuries involving skin, tendon, and bone:
Composite reconstruction through joint transfer may be considered.

4. Multidigital injuries using a "bank finger":
Useful in both acute situations or elective procedures.

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