Functional and aesthetic results of immediate reconstruction of traumatic thumb defects by toe-to-thumb transplantation

Abstract

Traumatic thumb defects significantly affect the function and appearance of the hand; thus, thumb reconstruction is very important in clinical practice. In our report, three reconstruction strategies of toe-to-thumb transplantation, based on the amputation level of the thumb, were used for immediate thumb reconstruction in 27 patients with traumatic thumb defects. All procedures were performed successfully. Patients were satisfied with the function and appearance of the reconstructed thumb. These results indicate that if the reconstruction method is properly selected based on the amputation level of the thumb, toeto-thumb transplantation is feasible for the immediate reconstruction of the thumb.

A Systematic Review of Outcomes of Toe-to-Thumb Transfers for Isolated Traumatic Thumb Amputation

“…Study Characteristics Twenty-five studies representing 450 toe-to-thumb transfers met the inclusion/exclusion criteria (Fig. 2) [3,6,9,12,15,18,22,24,26,30,31,33,35,36,38,39,43–46,49,51,53–55]. These studies were published between 1980 and 2010, and all used retrospective data.…”

Reconstruction of Fingers Using Skin-Bone Grafts with Microvascular Anastomoses

“…In addition, the following surgical manipulations were performed: formation of the ulnar supportive jaw combined with interposition of non-vascular bone graft (2) repair of a segmental defect in the metacarpal bone of the restored finger in combination with simultaneous replacement of the damaged finger in the total absence of the radial edge of the hand (2), repair of a subtotal segmental metacarpal defect (1). A fibula graft was used to form the ulnar supportive jaw (3).…”

“…At the current surgical practice of finger reconstruction, the second toe or part of the first toe on microvascular anastomoses are used together with relocation of a skin-bone radial flap on the peripheral vascular pedicle [1][2][3][4][5]. However, these interventions inevitably cause a defect in the donor area, which creates a number of difficult problems [1].…”

“…These approaches are still rarely used. Isolated cases of transplantation of a bone fragment from the lateral edge of the scapula, iliac wing, metatarsal fragment, or tibia crest have been reported; however, these reports have little clinical and anatomical rationale [1][2][3][4][5][6][7][8][9]. In most cases, the authors do not have adequate clinical material and do not provide long-term treatment results.…”

Toe-to-Hand Transfer: Evolving Indications and Relevant Outcomes

“…(24) Grip strength can be restored from approximately 70% of the contralateral hand when performing an immediate second to transfer, and up to 90% with osteo-onychocutaneous techniques. (25) Static two-point discrimination can be achieved to 10mm, and later sensory reorganization allows for ongoing improvements in perception of touch, and interpretation of signals from the transferred digit. However, a recent systematic review of the literature failed to identify any differences in outcomes by technique, largely due to the heterogeneity of current data, which is largely limited to smaller, single center studies and case series.…”