Evaluation of the child

Preoperative planning includes radiographs of the hand and feet. Radiographs are necessary to identify the skeletal base for the toe transfer. Although the metacarpal is commonly used, the distal radius or carpal bones may need to be used as a foundation. The role of angiography is

Fig. 3. (A, B) A 1-year-old girl with symbrachydactyly of her left hand with a thumb but absence of all four fingers. (C, D) Initially, the parents rejected the recommendation of a second toe-to-hand transfer, and she underwent a non-vascularized toe phalangeal bone graft in an attempt to reconstruct a post on the ulnar side of the hand. (E, F) She subsequently underwent a left second toe transfer into the small finger position at the age of 2.5 years. Photograph shows pinch and grasp function 4 years postoperatively. (G) The donor left foot 4 years postoperatively.

Fig. 3. (A, B) A 1-year-old girl with symbrachydactyly of her left hand with a thumb but absence of all four fingers. (C, D) Initially, the parents rejected the recommendation of a second toe-to-hand transfer, and she underwent a non-vascularized toe phalangeal bone graft in an attempt to reconstruct a post on the ulnar side of the hand. (E, F) She subsequently underwent a left second toe transfer into the small finger position at the age of 2.5 years. Photograph shows pinch and grasp function 4 years postoperatively. (G) The donor left foot 4 years postoperatively.

debatable. Some surgeons routinely obtain an arteriogram for each case, whereas others do not [7,37]. The authors do not routinely perform pre-operative angiography but map the dorsal and plantar arterial system in the foot with a handheld Doppler probe immediately preoperatively.

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