Toe to Thumb Transfer (original) (raw)
Related papers
Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation
Indian Journal of Plastic Surgery, 2012
ABSTRACTIn bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.
Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer
Plastic and reconstructive surgery, 2009
When replantation of an avulsed/amputated thumb is not feasible, toe-to-hand transfer may be considered as a reconstructive option in appropriately chosen patients. Although selection criteria are purposefully restrictive, immediate one-stage transfer, as opposed to a delayed procedure, provides many advantages. Primary reconstruction reduces hospitalization and operative and recovery time. It also may expedite return of function and allow patients to return to work sooner. The ability of the patient to undergo extensive microvascular reconstruction at the time of injury, the psychological preparation required, and the need to understand potential risks are important factors to consider.
Background Toe-to-thumb transfer is an established procedure for reconstruction of traumatic thumb amputations. The four types of toe-to-thumb transfers are the second toe, the great toe, the wrap-around great toe and the trimmed great toe transfers. The purpose of this study is to conduct a systematic review of the literature to compare outcomes amongst different methods of toe-to-thumb transfers. Methods A literature search using 'toe-to-thumb transfer' combined with 'thumb injury' and 'thumb reconstruction' as keywords and limited to humans and the English language identified 633 studies. Studies were included in the review if they: (1) present primary data, (2) report three or more toe-to-thumb transfers for isolated complete traumatic thumb amputation between the metacarpophalangeal joint and the interphalangeal joint (both excluded) and (3) present functional outcome data. Results Twenty-five studies representing 450 toe-to-thumb transfers met the inclusion criteria. They included 101 second toe transfers, 196 great toe transfers, 122 wrap-around transfers and 31 trimmed toe transfers. The mean survival rate was 96.4%. No statistically significant differences could be detected between the four transfers with regards to survival, arc of motion, total active motion, grip and pinch strength and static two-point discrimination. Conclusions All four types of toe transfer procedures have predictably high survival rates and good patient satisfaction scores. The current data are inadequate to make any comments with regards to donor site morbidity. Till such data are available, an evidence-based recommendation for the superiority of a specific type of toe-to-thumb transfer cannot be made.
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2003
Since the popularization of microvascular toe transfer, there has been a tendency to relegate osteoplastic reconstruction techniques for the thumb to history. A case is presented which shows that a successful and well-planned osteoplastic thumb reconstruction can match microsurgical reconstruction in all functional activities. Cosmetically, the toe transfer is the better reconstructive option but it may cause significant donor site morbidity.
2013
Amputation at the proximal phalanx or at the metacarpophalangeal joint can be treated by pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, or distraction lengthening. The best technique to use to treat these cases depends on the place of amputation and the patient's age, sex, occupation and functional demands. In the past 6 years, we treated 4 patients by lengthening the thumb metacarpal ray and adding a mini wraparound flap from the great toe. All the subjects were female with an average age of 22 years. All 4 patients had sustained traumatic amputations: 2 at the metacarpophalangeal joint and 2 at the base of the proximal phalanx. Distraction was completed approximately 65 days after osteotomy, obtaining an average lengthening of 23 mm. To achieve bone consolidation, the lengthener was left in place for 127 days on average. Microsurgical thumb reconstruction was performed around 3 months after consolidation of the osteotomy. There were no failures or cases of postoperative vascular compromise. The average pinch power was 66% of the opposite hand. The static 2-point discrimination of the reconstructed thumb was 8 mm (range, 7-10 mm). All patients reported being satisfied with the treatment, although 1 patient was partially dissatisfied due to the prolonged length of the treatment. Donor site morbidity was minimal. This procedure is mainly chosen by selected patients who refuse standard microsurgical thumb reconstruction because it requires a longer treatment period
The Journal of Hand Surgery, 2018
Thumb amputation at the carpometacarpal level is very incapacitating. Pollicization may be considered. We describe an alternate technique for thumb reconstruction at the level of the metacarpal base using a trimmed great toe along with a vascularized second metatarsophalangeal joint, including the second metatarsal, all supplied on a single vascular pedicle. Two patients who had a combined soft tissue defect and amputation of the thumb close to the carpometacarpal joint were reconstructed with this method. A transposition of the second toe was performed on top of the remaining proximal phalanx of the great toe to decrease donor site morbidity. This technique provides adequate length to the thumb without compromising another finger by creating a new thumb using a double microsurgical toe transfer on a single vascular pedicle. We minimize donor site morbidity by transposing the second toe onto the great toe.
2020
BACKGROUND Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor aesthetics. Great toe transplantation achieves better aesthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and aesthetic satisfaction in thumb reconstruction.METHODS We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a co...
Late results of replantations in tip amputations of the thumb
Acta Orthopaedica et Traumatologica Turcica, 2008
Amaç: Başparmak Tamai tip 1 amputasyonlarda uygulanan replantasyonlar geriye dönük olarak değerlendirildi. Çalışma planı: Çalışmaya, başparmak tırnak yatağı distalinde meydana gelen Tamai tip 1 amputasyonlar nedeniyle replantasyon uygulanan ve tedavi sonrasında dolaşım devamı sağlanan 14 hasta (12 erkek, 2 kadın; ort. yaş 28; dağılım 14-40) alındı. Tüm hastalarda santral digital arter anastomozu yapıldı. Anastomoza uygun ven bulunabilen dört hastada birer adet volar ven anastomozu yapıldı. Sinir tamiri sadece üç hastada yapılabildi. Duyu değerlendirmesi Semmes-Weinstein testi, iki nokta ayrım testi, hareketli iki nokta ayrım testi ve vibrasyon testi ile yapıldı; ayrıca, hastalar parmak atrofisi, soğuk intoleransı ve tırnak yatağı deformiteleri açısından incelendi. Ortalama takip süresi 11 ay (dağılım 6-48) idi. Sonuçlar: Semmes-Weinstein testi beş parmakta (%35.7) yeşil (dağılım 2.83-3.22), sekiz parmakta (%57.1) mavi (dağılım 3.22-3.61), bir parmakta (%7.1) mor (dağılım 3.84-4.31) idi. İki nokta ayrım testi ortalama skoru 6.9 mm (dağılım 3-11 mm), hareketli iki nokta ayrım testi ortalama skoru 4.5 mm (dağılım 3-6 mm) bulundu. Aynı elin sağlıklı parmaklarıyla karşılaştırıldığında, vibrasyon altı başparmakta (%42.9) artmış, altı başparmakta azalmış bulunurken, iki başparmağın (%14.3) vibrasyonu diğer parmaklarla eşit idi. Beş parmağın (%35.7) replante edilen kısmında atrofi; üçer hastada (%21.4) ise soğuk intoleransı ve tırnak deformitesi görüldü. Hastaların işe dönüş süreleri ortalaması 3.2 aydı (dağılım 2-6 ay). Çıkarımlar: Başparmak distal uç replantasyonları, teknik zorluklara rağmen, görünüm açısından ve fonksiyonel açıdan iyi sonuçlar vermektedir. Sinir tamiri yapılamayan olgularda da yeterli duysal iyileşme sağlanmaktadır.
Thumb reconstruction with toe transfer
Journal of hand and microsurgery, 2010
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.