Transferencia articular vascularizada: Reporte de caso / Free vascularized joint transfer: Case report

La articulación interfalángica proximal otorga la mayor contribución al arco total de movimiento digital, por lo tanto, la pérdida de movimiento normal de la articulación tiene un impacto considerable en la función y fuerza de agarre. El único método que asegura la preservación a largo plazo de la arquitectura cartilaginosa, así como una curación ósea rápida tras destrucción articular traumática o patológica es la transferencia articular vascularizada. Es definida como un trasplante articular parcial o completo con preservación o restauración inmediata del flujo de sangre. Se presenta el caso de un masculino de 20 años, con antecedente de trauma contuso-cortante en borde cubital de 3er dedo de mano izquierda zona II a quien se realiza cierre primario. Siete meses después a presentó deformidad articular e incapacidad funcional para la flexión de articulación interfalángica proximal. Se realizó procedimiento de reconstrucción articular, mediante transferencia articular vascularizada de 2° dedo del pie derecho. Posteriormente se dio seguimiento a través de consulta externa a las 2, 4, 6 y 8 semanas, 6 meses y 12 meses. A los 6 meses fue sometido a capsulotomía, liberación de placa volar, retiro de placas de osteosíntesis y adelgazamiento de isla cutánea. Se alcanzaron rangos de movimiento pasivo de extensión de 85° y activo de 70°. En base a la experiencia de nuestro centro se demuestra que el uso de transferencia articular en 2 etapas de reconstrucción, se pueden mantener rangos de movimiento tanto activo como pasivo suficiente para una adecuada función.

The proximal interphalangeal joint provides the greatest contribution to the total arc of digital movement, therefore, the loss of normal movement of the joint has a considerable impact on function and grip strength. The only method that ensures the long-term preservation of the cartilaginous architecture, as well as a rapid recovery of traumatic or pathological joint destruction, is vascularized joint transfer. It is defined as a partial or complete partial transplant with preservation or immediate restoration of blood flow. We present the case of a 20-year-old man, with a history of contusive-cutting trauma on the ulnar border of the third finger of the left hand, area II, who underwent primary closure. Seven months after the presentation of the joint and functional disability for proximal interphalangeal joint flexion. A joint reconstruction process was performed, by means of a vascularized joint transfer of the 2nd toe of the right foot. Subsequently, follow-up was carried out through the outpatient clinic at 2, 4, 6 and 8 weeks, 6 months and 12 months. At 6 months he was subjected capsulotomy, volar plate release, osteosynthesis plates removal and cutaneous island thinning. Ranges of passive movement of extension of 85° and active of 70° were reached. Based on the experience of our center, it is shown that the use of the transfer was made in 2 stages of reconstruction, the range of both active and passive movements can be maintained for an adequate function.

Changing Paradigms in the Treatment of Radial Club Hand: Microvascular Joint Transfer for Correction of Radial Deviation and Preservation of Long-term Growth

Radial longitudinal deficiency, also known as radial club hand, is a congenital deformity of the upper extremity which can present with a spectrum of upper limb deficiencies. The typical hand and forearm deformity in such cases consists of significant forearm shortening, radial deviation of the wrist and hypoplasia or absence of a thumb. Treatment goals focus on the creation of stable centralized and functionally hand, maintenance of a mobile and stable wrist and preservation of longitudinal forearm growth. Historically centralization procedures have been the most common treatment method for this condition; unfortunately centralization procedures are associated with a high recurrence rate and have the potential for injury to the distal ulnar physis resulting in a further decrease in forearm growth. Here we advocate for the use of a vascularized second metatarsophalangeal joint transfer for stabilization of the carpus and prevention of recurrent radial deformity and subluxation of the wrist. This technique was originally described by the senior author in 1992 and he has subsequently been performed in 24 cases with an average of 11-year follow-up. In this paper we present an overview of the technique and review the expected outcomes for this method of treatment of radial longitudinal deficiency.

Changing Paradigms in the Treatment of Radial Club Hand: Microvascular Joint Transfer for Correction of Radial Deviation and Preservation of Long-term Growth

Radial longitudinal deficiency, also known as radial club hand, is a congenital deformity of the upper extremity which can present with a spectrum of upper limb deficiencies. The typical hand and forearm deformity in such cases consists of significant forearm shortening, radial deviation of the wrist and hypoplasia or absence of a thumb. Treatment goals focus on the creation of stable centralized and functionally hand, maintenance of a mobile and stable wrist and preservation of longitudinal forearm growth. Historically centralization procedures have been the most common treatment method for this condition; unfortunately centralization procedures are associated with a high recurrence rate and have the potential for injury to the distal ulnar physis resulting in a further decrease in forearm growth. Here we advocate for the use of a vascularized second metatarsophalangeal joint transfer for stabilization of the carpus and prevention of recurrent radial deformity and subluxation of the wrist. This technique was originally described by the senior author in 1992 and he has subsequently been performed in 24 cases with an average of 11-year follow-up. In this paper we present an overview of the technique and review the expected outcomes for this method of treatment of radial longitudinal deficiency.

Tenolysis after the Reconstruction of PIP Joint of the Finger using Second Toe PIP Joint Free Flap

PURPOSE: The second toe PIP joint free flap is a method of reconstruction used for abnormalities of the PIP joint of the finger. We report the results of the additional tenolysis in patients with a difference between passive ROM and active ROM after second toe PIP joint free flap. METHODS: From March 2001 to July 2008, tenolysis was performed in patients with a difference in their active and passive ROM after second toe PIP joint free transfer, performed on 14 fingers. We performed a retrospective analysis of the medical records, noting the clinical and radiological findings. In addition, we measured the preoperative and postoperative range of motion of the PIP joint. RESULTS: The average active ROM was 22.5degrees in three months after the joint transfer surgery, and was 38degrees after additional tenolysis from five months to twelve months after the joint transfer. CONCLUSIONS: Additional tenolysis, after the second toe PIP joint free flap, might be a good option with an improved results in patients with difference in active and passive ROM of a transferred PIP joint.

Experience of Vascularized Joint Transfer for Segmental Loss of M-P Joint: A Case Report / 대한정형외과학회잡지

Restoration of the M-P joint of a damaged or lost joint by trauma, tumor and others is necessary for adequate function of the hand. Several procedure have been described for restoration of the M-P joint. We experienced a case of vascularized joint transter for a lost joint by trauma. After 1 year and 2 months follow-up, there have been no degenerative change and no pain.