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Review
. 2022 Nov 21;36(4):243-252.
doi: 10.1055/s-0042-1758689. eCollection 2022 Nov.

Great Toe Transplantation

Antonio J Forte  1 , Karla C Maita  1 , Ricardo A Torres-Guzman  1 , Francisco R Avila  1 , Bauback Safa  2 , Gregory Buncke  2 , Rudolph Buntic  2 , Andrew Watt  2
Affiliations
Review

Great Toe Transplantation

Antonio J Forte et al. Semin Plast Surg. .

Abstract

Despite being relatively uncommon in the general population, thumb amputations cause severe disability. More than 3,300 thumb amputations occurred in the United States. The thumb makes up around 40% of the function of the hand. Therefore, losing it would result in significant medical, hospital, and societal costs. Thumb reconstruction surgery's primary goal is to restore grip strength, including the range of motion, fine and tripod pinch, power grasp, strength, and sensibility, while secondary goals include restoring hand aesthetics. In cases of thumb replantation, like-for-like replacement is possible; however, when thumb replantation is not possible, great toe-to-hand transplantation is the best available reconstruction. When compared with other reconstructive options such as osteoplastic thumb reconstruction, pollicization, second toe transplantation, and the use of a thumb prosthesis, great toe transplantation provides superior function and aesthetics. For restoring pinch, sensitivity, strength, and aesthetics of the hand with well-tolerated donor site morbidity, toe to thumb transplantation is regarded as the gold standard.

Keywords: amputation; extremities; microsurgery; reconstructive surgical procedures; thumb; vascularized composite allotransplantation.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Great toe transplant, artist rendering.
Fig. 2
Fig. 2
( A ) Complex thumb amputation. ( B ) Thumb amputation status post-stabilization. ( C ) Lateral arm flap design, in situ. ( D ) Lateral arm flap. ( E ) Lateral arm flap inset for soft tissue reconstruction.
Fig. 3
Fig. 3
( A ) Thumb amputation with healed lateral arm flap in preparation for toe transplantation, lateral. ( B ) Thumb amputation with healed lateral arm flap in preparation for toe transplantation, volar. ( C ) Great toe markings, dorsal foot. ( D ) Great toe markings, plantar foot. ( E ) Great toe, in situ harvest. ( F ) Great toe postharvest. ( G ) Great toe inset, volar. ( H ) Great toe inset, lateral.
Fig. 4
Fig. 4
Structural reassignment in great toe transplantation.
Fig. 5
Fig. 5
Great toe transplant 6 months postop. ( A ) Volar. ( B ) Dorsal. ( C ) Lateral grip. ( D ) Volar grip. ( E ) Lateral. ( F ) Opposition.
Fig. 6
Fig. 6
Structural reassignment in great toe wraparound flap.
Fig. 7
Fig. 7
Great toe wraparound flap, artist rendering.
Fig. 8
Fig. 8
Great toe wraparound flap, clinical case. ( A ) Soft tissue amputation of thumb, dorsal. ( B ) Soft tissue amputation of thumb, volar. ( C ) Great toe wraparound markings. ( D ) Great toe wraparound, in site harvest. ( E ) Donor site closure. ( F ) Great toe wraparound inset, dorsal. ( G ) Great toe wraparound inset, lateral.
See this image and copyright information in PMC

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