Pavel A Matveev, traumatologist-orthopedist; Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: firstname.lastname@example.org; https://orcid.org/0000-0002-0455-740X.
Ludmila M Smirnova, Grand PhD in Engineering sciences, leading researcher of the Department of Biomechanical Studies of the Musculoskeletal System of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Professor of Department of Biomedical Engineering, St. Petersburg Electrotechnical University “LETI”, 5 Professora Popova Street, 197376 St. Petersburg, Russian Federation; e-mail: email@example.com; https://orcid.org/0000-0003-4373-9342.
Igor V Shvedovchenko, MD, Grand PhD in Medical sciences, Professor, Scientific Supervisor of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: firstname.lastname@example.org; https://orcid.org/0000-0003-4618-328X.
Andrey A Koltsov, PhD in Medical sciences, Head of the First Child’s Traumatology-Orthopedic Department, traumatologist-orthopedist, pediatric surgeon of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: email@example.com; https://orcid.org/0000-0002-0862-8826.
In the heading: Original researches
Year: 2023 Volume: 5 Journal number: 1
Article type: scientific and practical
Introduction. Habilitation of patients with reduction hand anomalies in children is an important task, the success of which depends on the degree of integration into society, socialization and quality of life in general. One of the methods of treatment is non-blooded toe phalanges autotransplantation. At the same time, the question of the effect of the operation on the function of the hand and further life activity remains insufficiently studied.
Aim. The aim of the study is to conduct a comprehensive assessment of the results of surgical treatment of the hand by non-blooded toe phalanges transplantation in children.
Materials and methods. We examined 34 patients with reduction hand anomalies who received surgical treatment by non-blooded toe phalanges autotransplantation in the clinic of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled in the period from 2013 to 2022. The study took into account the data of clinical examination, the results of radiation diagnostics, questionnaires using the questionnaires DASH and AbilHand -Kids. A comprehensive assessment of the obtained data was performed using the Brief International Classification of Functioning, Disability and Health Core Set for Hand Conditions to assess the condition of patients with upper limb malformations.
Results. The severity of impairments in the structure of the hand, the functions of mobility and stability of the joints, the indicators of the potential ability of activity and the participation of patients with deformities of the hand before and after the start of treatment were assessed. The obtained estimates are expressed using the conceptual language and scales of the International Classification of Functioning, Disability and Health. Analysis of the results with a quantitative assessment confirmed the reduction of structural hand disorders achieved with the help of surgical treatment, improvement of mobility and stability of the joints of the affected rays of the hand in case of hypoplasia, brachydactyly and ectrodactyly. An increase in the potential ability of activity and participation of patients after surgical treatment of reduction hand anomalies by the method of non-vascularized toe phalanges autotransplantation was revealed.
Discussion. As a result of the treatment, children achieved a higher ability to perform or cope with the task or action without auxiliary means or outside help, in particular at home and in everyday life, when performing actions involving fine motor skills of the hand, with the need to exert effort, in self-service. The increase in the level of the potential ability and participation of the child is explained by the achieved increase in the mobility and stability of the joints of the affected rays of the hand, and the improvement of these functions of the hand is due to the normalization of its structure as a result of surgical treatment.
Conclusion. It is advisable to evaluate the results of surgical treatment of reduction hand anomalies by nonblooded toe phalanges autotransplantation using the International Classification of Functioning, Disability and Health and a set of methods, including clinical examination, radiography, computed tomography, questionnaires on DASH and AbilHand – Kids questionnaires before and after treatment. A comprehensive evaluation of the results of surgical treatment of reduction hand anomalies confirmed the pronounced positive functional effect of the method of non-blooded toe phalanges autotransplantation, which is expressed in improving the state of the structure and functions of the hand, increasing the potential ability of activity and participation of patients, and their quality of life.
Keywords: classification of functionality, foot, habilitation, hand, reconstruction, results, transplantation
Download the full text of the article
1. Swanson AB, Swanson GD, Tada K. A classification for congenital limb malformation. J. Hand Surg. Am. 1983;8 (5 Pt 2):693-702. DOI: 10.1016/s0363-5023(83)80249-4.
2. Tonkin MA. Classification of congenital anomalies of the hand and upper limb. J. Hand Surg. Eur. 2017;42(5):448-56. DOI: 10.1177/1753193417690965.
3. Golyana SI, Shvedovchenko IV, Kochish AY. Klassifikatsiya posttravmaticheskikh defektov i deformatsii kisti i predplechya u detei: patologiya s utratoi distalnikh segmentov kisti [Classification of post-traumatic defects and deformations of the hand and forearm in children: pathology with loss of distal segments of the hand]. Sovremennie problemi nauki i obrazovaniya [Modern problems of science and education]. 2020;(6):142. DOI: 10.17513/spno.30327. (In Russian).
4. Golyana SI, Shvedovchenko IV, Kochish AY. Klassifikatsiya posttravmaticheskikh defektov i deformatsii kisti i predplechya u detei: patologiya bez utrati distalnikh segmentov kisti [Classification of post-traumatic defects and deformations of the hand and forearm in children: pathology without loss of distal segments of the hand]. Sovremennie problemi nauki i obrazovaniya. [Modern problems of science and education]. 2021;(1):66. DOI: 10.17513/spno.30398. (In Russian).
5. Tyazhelkov AP. Vrozhdennie poroki kisti s nedostatochnim razvitiem sostavlyayushchikh
elementov [Congenital malformations of the hand with insufficient development of the constituent elements]. Zdravookhranenie Dalnego Vostoka [Healthcare of the Far East]. 2014;62(4):65-72. (In Russian).
6. Shvedovchenko IV. Lechenie detei s vrozhdennimi porokami razvitiya verkhnikh konechnostei [Treatment of children with congenital malformations of the upper limbs]. Travmatologiya i ortopediya: rukovodstvo dlya vrachei: v 4 t. — T.2: Travmi i zabolevaniya plechevogo poyasa i verkhnei konechnosti [Traumatology and orthopedics: a guide for physicians: in 4 volumes — V.2: Injuries and diseases of the shoulder girdle and upper limb]. Pod red. N.V. Kornilova i E.N. Gryaznukhina
[ed. NV Kornilov and EN Gryaznukhin]. St. Petersburg: Hippocrates, 2005. 538 p. (In Russian).
7. Buck-Gramcko D. Congenital malformations of the hand and forearm. Chir Main. 2002;21(2):70-101. DOI: 10.1016/s1297-3203(02)00103-8.
8. Kotkansalo T, Vilkki S, Elo P, Luukkaala T. Long-term functional results of microvascular toe-to-thumb reconstruction. J. Hand Surg Eur Vol. 2011;36(3):194-204. DOI: 10.1177/1753193410387331.
9. Kotkansalo T, Vilkki S, Elo P. Long-term results of finger reconstruction with microvascular toe transfers after trauma. J. Plast. Reconstr. Aesthet. Surg. 2011;64(10): 1291-9. DOI: 10.1016/j.bjps.2011.04.036.
10. Broadbent TR, Woolf RM. Thumb reconstruction with contiguous skin-bone pedicle graft. A case report. J. Plast. Reconstr. Surg. 1960:494-9. DOI: 10.1097/00006534-196011000-00002.
11. McGregor IA, Simonetta C. Reconstruction of the thumb by composite bone-skin flap. Br. J. Plast. Surg. 1964:3748. DOI: 10.1016/s0007-1226(64)80007-2.
12. Mowlem R. Bone grafting. Br. J. Plast. Surg. 1963:293304. DOI: 10.1016/s0007-1226(63)80133-2.
13. Wolff H. Diskussion zu Lexer; Gelenktransplantation. «Verhandhingen der Deutschen Gesellschaft fur Chirurgie. Berlin: Kongress 39». 1910:105-6.
14. Carroll RE, Green DP. Proceedings of the American Society for Surgery of the Hand. J. Bone Joint Surg. Am. 1975;57-A (5):727. DOI: 10.2106/00004623-197557050-00038.
15. Goldberg NH, Kirk-Watson H. Composite toe (phalanx and epiphysis) transfers in the reconstruction of the aphalangic hand. The Journal of Hand Surgery. 1982;7(5):454-9. DOI: 10.1016/s0363-5023(82)80039-7.
16. Buck-Gramcko D. The role of nonvascularized toe phalanx transplantation. J. Hand Clin. 1990;6(4):643-59. DOI: 10.1016/s0749-0712(21)01061-1.
17. Gohla T, Metz Ch, Lanz U. Non-vascularized free toe phalanx transplantation in the treatment of symbrachydactyly and constriction ring syndrome. J. Hand Surg. Br. 2005;30(5):446-51. DOI: 10.1016/j.jhsb.2005.06.003.
18. Kawabata H, Tamura D. 5- and 10-Year FollowUp of Nonvascularized Toe Phalanx Transfers. J. Hand Surg. Am. 2018;43(5): 485.e1-485.e5. DOI: 10.1016/j.jhsa.2017.10.034.
19. Shvedovchenko IV, Koltsov AA, Matveev PA, Komarova AV. Peresadka nekrovosnabzhaemyh falang pal’cev stopy na kist’ pri vrozhdennoj i priobretennoj patologii (chast’ 1) [Nonvascularized toe-phalanges transplantation to the hand in congenital and acquired pathology (Part 1)]. Ortopediya, travmatologiya i vosstanovitelnaya khirurgiya detskogo vozrasta [Pediatric Traumatology, Orthopaedics and Reconstructive Surgery]. 2022;10(2):161-70. DOI: 10.17816/PTORS104615. (In Russian).
20. Matveev PA, Shvedovchenko IV, Koltsov AA. Transplantatsiya nekrovosnabzhaemikh falang paltsev stopi pri vrozhdennikh nedorazvitiyakh kisti [Non-vascularized toe phalanges transplantation in congenital hand malformations]. Vestnik travmatologii i ortopedii im NN Priorova [Journal of Traumatology and Orthopedics NN Priorov]. 2022;29(2):193-204. DOI: 10.17816/vto108463. (In Russian).
21. Matveev PA, Shvedovchenko IV, Smirnova LM, Koltsov AA. Otsenka sostoyaniya stopi posle zaimstvovaniya nekrovosnabzhaemikh falang paltsev dlya autotransplantatsii na kist [Assessment of the Foot Donor Site Morbidity After Non-Vascularized Toe Phalanx Transfer to the Hand]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2022;28(3):49-62. DOI: 10.17816/2311-2905-1784. (In Russian).
22. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am. J. Ind. Med. 1996 Jun; 29(6):602-8. DOI: 1O.1O02/(SICI)1O97-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L.
23. Arnould C, Penta M, Renders A, Thonnard J-L. ABILHAND-Kids: a measure of manual ability in children with cerebral palsy. Neurology. 2004;63(6):1045-52. DOI: 10.1212/01.wnl.0000138423.77640.37.
24. Mezhdunarodnaya klassifikatsiya funktsionirovaniya, ogranichenii zhiznedeyatelnosti i zdorovya [International classification of functioning, disability and health]. per. GD Shostka i dr. [GD Shostka et al.]. WHO, Geneva. M., 2001. 342 p. (In Russian).
25. Mezhdunarodnaya klassifikatsiya funktsionirovaniya, ogranichenii zhiznedeyatelnosti i zdorovya (polnaya
versiya) [International classification of functioning, disability and health (full version)]. pod red. [ed.] GD Shostka, MV Korobova, AV Shabrova. SPb: Sankt-Peterburgskii institut usovershenstvovaniya vrachei ekspertov [St. Petersburg: St. Petersburg Institute of Advanced Medical Experts], 2003. 342 p. (In Russian).
26. Mezhdunarodnaya klassifikatsiya funktsionirovaniya, ogranichenii zhiznedeyatelnosti i zdorovya (MKF) (s izmeneniyami i dopolneniyami po sostoyaniyu na 2016 g.) [International Classification of Functioning, Disabilities and Health (ICF) (with amendments and additions as of 2016)]. Proekt — SPb: Chelovek [Project — St. Petersburg: Human], 2017. — 262 p. (In Russian).
27. ICF Core Set for Hand Conditions // ICF Research Branch. 2017. Available at: https://icf-research-branch. org/icf-core-sets-projects2/other-health-conditions/ development-of-icf-core-sets-for-hand-conditions. (accessed 25.01.2023).