Free Toe Phalanx Transfer for Finger Lengthening in Brachydactyly.
(Transfer of Toe Bone to Lengthen a Short Finger)

Introduction

A child of 15 months was brought to us with Brachydactyly(short fingers) involving all four fingers of his left hand. The thumb was of adequate functional length.  In such condition to achieve a useful hand function we need to create an opposing post by lengthening one of the short fingers.  The classic method is by microsurgical transfer of a complete second toe on top of the existing short toe. When parents are not willing for toe transfer free phalangeal transfer from one of the toes is an option.

Operative Technique

Normally in each of the fingers there are three phalanges (small bones).  In this child there was only one proximal phalanx in all the fingers.  The little finger had an empty sleeve of skin.  Therefore it was planned to lengthen the finger using a free phalangeal bone graft from the third toe. The toe was exposed through a dorsal incision and the proximal phalanx was harvested along with the growth plate extra periosteally.  The skin sleeve in the hand is approached via dorsal incision.    The graft is fixed with a straight K wire.  The donor was site closed directly.  

Result

At 1 year follow up the phalanx graft has survived. The epiphysis is open and has growth potential. The little finger is stable and the child is using the finger for holding objects.

Discussion

Lengthening of  short digit in congenital mal formation is difficult because any bone graft when placed on top of the existing bone will under go some resorption.  Only the periostium covered proximal toe phalanx will withstand resorption and show a complete take.  It is also possible to construct a new joint with the cartilage covered distal end of the recipient bone. Free phalangeal transfer in the reconstruction of Brachydactyly is a very good option but has to be done preferably within 12 months of age. As the transferred bone graft has good growth potential, the growth of the finger is satisfactory and useful function. The donor site morbidity can be reduced by transferring a iliac crest bone graft into the toe.  

Surgeons

Dr. S Raja Sabapathy
Dr. Ravindra Bharathi
Dr. Hari Venkatramani

Anaesthesiologists

Dr. V  Ravindra Bhat
Dr. G. Venkateswaran