Objective: The purpose of this study was to evaluate long-term outcomes of free nonvascularized toe phalanx transfer to reconstruct synbrachydactylic hands in children. Materials and Methods: We retrospectively reviewed 54 free nonvascularized toe transfers in 29 children with congenitally short fingers. Growth rate was calculated at 5-year follow-up and 10-year follow-up. Percent length against the original phalanx, remaining in the contralateral foot, was also calculated. When bilateral phalanx of the fourth toes was used, average length of the proximal phalanx of the third and fifth toes was used as a substitute. Incidence of the early physeal closure was recorded. Toe phalanx was harvested according to the technique described by Buck-Gramko in 1990. Fingers were explored using mid-dorsal longitudinal incisions. If remnant of the proximal phalanx was present, the toe phalanx was placed on the top of the remnant with 3 or 4 nonabsorbable sutures. If there was no remnant, loop of the extensor and flexor tendons were cut at the metacarpal head, and they were sutured with the toe phalanx that was held on the top of the metacarpal with 1 Kirschner wire. Collateral ligaments were also reconstructed. Results: Age at operation was 1.5 years on average. The proximal phalanx of the fourth toe was used in 51 and that of the third toe in 3. Seven toes were trimmed because the skin pocket was tight. Silastic expander was used for tissue expansion before toe phalanx transfer in 4 cases. Five cases required revision surgery for partial necrosis of the skin pocket. Five children (7 toes) were lost before 5-year follow-up, and hence excluded for evaluation. Six children underwent bone lengthening procedure between 5- and 10-year follow-up period, and 10 children did not reach 10 years after surgery. They, too, were excluded for the evaluation at 10-year follow-up. At 5-year follow-up, the physis was closed in 30%, growth rate was 0.8 mm/year, and %length was 87%. At 10-year follow-up, closure rate increased to 85%, growth rate decreased to 0.5 mm/year, and %length was 69%. Conclusion: Free nonvascularized toe phalanx transfer is a versatile procedure for reconstruction of the congenital finger deficit. Growth ability remains at least 5 years in most of the cases but it decreases when they reached 10-year follow-up period.
