Advances in microsurgical reconstruction of the congenitally adactylous hand.

A series of 18 microsurgical toe transfers for congenitally adactylous hands was done from 1983 to 1994. The functional results achieved depended on the approach and technical features applied to hand reconstruction in congenital amputations. Function was improved significantly by using 3-jointed second toes, including the metatarsophalangeal joint, and by performing meticulous intrinsic repair. The use of donor arteries changed during the 11-year study period toward the goal of perfect revascularization with a minimized ischemic time. Abundant nerve supply was found to be important for achieving near normal growth of the transferred digit. The results showed improvement in the use of the defective extremities. The ability to pinch was restored successfully in 14 of 17 congenitally defective extremities. Growth measurements were obtained from 11 transfers at followup, which ranged from 1.5 to 6 years (mean, 4 years). Linear growth was observed at the phalangeal epiphyses, whereas the metatarsal head epiphyses showed clear disturbances in at least 2 patients.