Customizing extensor reconstruction in vascularized toe joint transfers to finger proximal interphalangeal joints - a strategic approach for correcting extensor lag.

Introduction: Vascularized toe proximal interphalangeal joint transfers (VJT) allows the restoration of damaged joints. However, extensor lag and poor arc of motion (AOM) have been reported. We present our outcomes treated according to a novel reconstructive algorithm addresses extensor lag and allows for consistent results post-operatively. Material and methods: VJTs were performed in a consecutive series of 26 digits in 25 patients. The average age was 30.5 years. There were 14 right hands (dominant) and 12 left. Reconstructed digits included 8 index, 10 middle, and 8 ring fingers. Simultaneous extensor reconstructions were performed and 8 were centralization of lateral bands, 5 direct EDL-to-EDC repairs and 13 central slip reconstructions. Results: The average length of follow up was 16.7 months. Average extension lag of 17.9[degrees] was noted at the last follow-up. The AOM was 57.7[degrees] (81.7% functional usage of pre-transferred toe PIPJ AOM). There was no significant difference in the reconstructed PIPJ AOM between the handedness (p= 0.23), recipient digits (p= 0.37) or surgical experience in VJTs (p= 0.25). Comparing the outcomes of different techniques of extensor mechanism reconstructions, the extension lag of centralization, direct EDL-to-EDC repair, and central slip reconstruction was 19.4[degrees], 13[degrees], and 18.8[degrees] (p= 0.42) respectively; The AOM was 54.4[degrees], 55[degrees], and 60.8[degrees] (p= 0.42); The reconstructed finger AOM compared to the pre-transferred toe PIP joint AOM was 76.3%, 79.7%, and 85.9% (p= 0.34). Discussion: With this treatment algorithm, consistent outcomes can be produced with minimal extensor lag and maximum usage of potential toe PIPJ AOM. (C)2016American Society of Plastic Surgeons

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