A novel technique for correcting extensor lag in vascularized toe PIP joint transfers

The use of the vascularized second-toe proximal interphalangeal joint (PIPJ) for vascularized joint transfers (VJTs) allows for restoration of powerful pinch/grasp and range of movement of a PIPJ in the hand. However, because of the lack of central slip formation in the majority of toes, the reconstructed PIPJ often results in extension lag. Extension lag associated with poor central slip formation in the lesser toes can be corrected using central slip reconstruction methods such as the Stack method. However, such methods are often cumbersome and involve extensive dissection and soft tissue manipulation. We present a novel, reproducible, simple yet effective technique in recreating the insertion point of the extensor tendon in the reconstructed finger, hence correcting the issue of extensor lag in vascularized toe joint transfers. The crux of this technique empowers the surgeon with the ability to correct inherent extensor lag of toes in VTJs. This will hence nullify "toe PIPJ angles" as a preselection criteria in determining patients suitable for VJT, thus enabling more patients to benefit from VJTs.