Thumb reconstruction with toe transfer

Abstract

Microsurgical toe transfer has become a gold standard option for amputated thumb reconstruction. It can be used to correct almost any thumb defect. However, for optimal functional and esthetic results, proper initial care, preoperative planning, proper selection of suitable techniques, adjunct or secondary procedures and proper, postoperative rehabilitation are important.

Keywords: Microsurgery; Thumb amputation; Toe-to-thumb transfer.

Fig. 1

Provision of initial coverage with a pedicled groin flap. a Coverage defect involving the thumb and dorsum of the hand. b Hand appearance after pedicled groin flap reconstruction and before secondary toe transfer.

Fig. 2

Thumb reconstruction with a second toe. a Four flaps elevated in the amputation stump. b, c Appearance of the second toe-to-thumb reconstruction

Fig. 3

a, b Appearance of the trimmed great toe-to-thumb reconstruction (volar and lateral views)

Fig. 4

a. A 5-mm stump at the base of the proximal phalanx is preserved and interosseous wire is inserted for osteosynthesis. b Composite metatarso- (metacarpo-) phalangeal joint repair

Fig. 5

A dorsal metatarsal artery-dominant vascular pedicle, exposed through a retrograde dissection

Fig. 6

Harvesting a trimmed great toe. a Design of the skin incision. b Peri-joint flap is elevated and a longitudinal osteotomy is made through the interphalangeal joint and both proximal and distal phalanges. c Excess peri-joint flap is trimmed and a stable joint is reconstructed

Fig. 7

Both interphalangeal and metacarpophalangeal joints are kept in extension for 2–4 weeks after transfer