Free Vascularized Transfer of the Metatarsophalangeal and Proximal Interphalangeal Joints of the Second Toe for Reconstruction of the Metacarpophalangeal Joints of the Thumb and Index Finger Using a Single Vascular Pedicle

Previously described double-joint transfers from a single toe have required a separate vascular pedicle for each joint transferred. In this case report, however, we describe the use of a single vascular pedicle to perform a free vascularized double-joint transfer of the metatarsophalangeal and proximal interphalangeal joints of a single toe to the metacarpophalangeal joints of the thumb and index finger. Although a pollicization could have restored adequate function to the patient's hand, she desired five digits. Given the increased distance between the metacarpophalangeal joints of the thumb and index finger, an increased interjoint pedicle length was needed. We obtained this by mobilizing the digital vessels away from the joints of the second toe. This involved transecting the tibial digital vascular branches of the proximal interphalangeal joint and the fibular vascular branches of the metatarsophalangeal joint. Based on a single pedicle, the vascularity of the proximal interphalangeal joint was maintained by preserving the distal commissural vessels at the distal phalanx. Advantages of this technique include using a single donor artery and reconstruction of two metacarpal joints with a single toe.