Summary
Although toe-to-hand transfer has a defined role in the management of congenital hand
deformities, it remains unclear how well children integrate the transferred digits
into physiological grasping. We analysed fingertip forces in the precision grip of
13 patients when lifting a test object more than three years after free toe transfer
for absent or hypoplastic digits. Clinically, most patients showed normal sensibility
of transferred digits, but active motion and pinch strength were limited as compared
to the normal hand. For the control of fingertip forces, two key features of the normal
two-digit opposition grip were seen in all operated hands: adaptation of grip force
to object weight and parallel coordination of lift and grip forces. These physiological
grasping strategies developed independently of the patients' age at the time of operation,
which ranged from one to 13 years. In four patients, we observed increased tangential
load forces with the operated hand due to misalignments in the application of fingertips
on the grasp surfaces. Such forces lead to increased grip force requirements on both
fingers that may overload transferred digits with limited motor function. The need
for optimal alignment of the grip axis during toe-transfer surgery is emphasised.
Keywords
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Article info
Publication history
Published online: August 10, 2006
Accepted:
April 20,
2006
Received:
December 9,
2005
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
