[Reconstruction of metacarpophalangeal joint defect by the second toe proximal interphalangeal joint with skin flaps].

OBJECTIVE: To investigate the operative method and clinical efficacy of reconstructing metacarpophalangeal joint defect by the second toe proximal interphalangeal joint with skin flaps.

METHODS: From March 2003 to January 2008, 26 cases (26 fingers) with metacarpophalangeal joint defect were treated, including 19 males and 7 females aged 18-36 years old (average 27 years old). Among them, 23 cases were caused by mechanical injury and the time from injury to operation was 1-6 hours; while 3 cases suffered from secondary injury due to trauma and the time from injury to operation was 3-12 months. Four thumbs, 10 index fingers, 8 middle fingers, 3 ring fingers and 1 little finger were injured. The metacarpophalangeal joint defects were 2 cm x 1 cm - 4 cm x 2 cm in size, and 22 cases were combined with skin and soft tissue defect (1.5 cm x 1.5 cm - 6.0 cm x 5.0 cm). During operation, the second toe proximal interphalangeal joint with skin flaps was transplanted to reconstruct those defects, 20 fingers received whole-joint transplantation and 6 fingers received half-joint transplantation. The skin flaps ranging from 2.0 cm x 1.5 cm to 6.5 cm x 6.0 cm in size were adopted. The donor site of 21 cases received toe amputation, and the rest 5 cases received joint fusion.

RESULTS: The transplanted joints and skin flaps of all the 26 fingers survived. All incisions and donor sites healed by first intention. All patients were followed up for 6-20 months (average 12 months). The union of transplanted joints was achieved in all the cases at 6-12 weeks after operation, no bone nonunion and refracture occurred. The flexion range of transplanted metacarpophalangeal joints was 30-75 degrees (average 45 degrees). Joint activity was evaluated according to the total active movement/total passive movement assessment criteria, 8 fingers were excellent, 13 good, 3 fair, 2 poor, and the excellent and good rate was 80.77%. The foot donor-site ability to walk was unaffected.

CONCLUSION: Applying second toe proximal interphalangeal joint with skin flaps is an effective approach to reconstruct the metacarpophalangeal joint defect, and the function recovery of the injured joints is satisfying.