Long-term results of digital reconstruction using toe-to-finger transfers

In the period 1987–2002, 147 toe-to-hand transfers were performed in 111 patients. Traumatic amputation was reconstructed by transfer of 131 toes in 101 patients; congenital anomaly was treated in 10 patients by transplantation of 16 toes. In this study, 60 reconstructed hands were evaluated in 59 patients. Patients were divided into 12 groups according to the type of reconstruction. Group A includes patients with thumb reconstruction using the great toe, wrap-around flap, or second toe transfer. Group B involves patients with thumb and second finger reconstruction; group C comprises cases of second and third finger reconstruction. Group D involves patients with “claw hand” type of reconstruction, group E includes patients with metacarpal hand reconstruction, and finally group F comprises cases with congenital anomalies. Post-transfer total range of motion and sensitivity were measured on transplanted toes. Functional ability was evaluated by the performance of 20 selected activities of daily life. Successful rate of transfer was 94.6% in post-traumatic transplantation and 100% in congenital anomalies reconstruction. The average total range of motion and two-point discrimination sensitivity was 53° and 11 mm, respectively. The best results, judged by grasping ability, were achieved in group B (thumb and second finger reconstruction), group C (second and third finger reconstruction), and, surprisingly, group E (metatarsal hand). Grasping ability was significantly lower in group D (“claw hand” type of reconstruction) and group F (congenital hand anomalies). The highest patient satisfaction was achieved in cases of thumb and metacarpal hand reconstruction.