Traditionally, toe-to-hand transfers have been reserved for thumb amputations or for use after severe mutilating injuries. The authors report their experience with the use of second toe-for-finger amputations with preserved or reconstructible proximal interphalangeal joints in manual workers. The aim of the procedure was to reduce impairment and to upgrade the hand from a functional and cosmetic standpoint. Fifteen second-toe wrap-around or variations were carried out on 11 adults (18 to 41 years old). Four patients with two or more finger amputations received two sequential second toes; four patients with two finger amputations received one toe; and each of three patients with single-digit amputation received a single toe. All but one amputation were performed less than 3 weeks after the accident. All toes survived. Range of motion at the native proximal interphalangeal joint was more than 90 percent in all patients but one; however, it was minimal at the transplanted joints. Patient satisfaction was high from a cosmetic and functional standpoint. Ten of 11 laborers resumed their previous activity. On the basis of this experience, a classification with aesthetic and functional implications is proposed to help in the decision-making process when dealing with multidigital injuries. It is concluded that second-toe transfer is an excellent choice for finger amputation distal to the proximal interphalangeal joint in laborers. Its prime indication is for amputations of two fingers where at least one toe should be transferred, as required, to achieve an “acceptable hand” (three-fingered hand). Early transfer allows salvage of critical structures from the damaged finger, such as joints, tendons, and bone, that otherwise would be lost. Early transplantation is highly recommended.
From the Instituto de Cirugía Plástica y de la Mano, the Hospital Mutua Montañesa, and Clínica Mompía.
Received for publication July 22, 2002;
revised December 4, 2002.
Presented in part at the 10th Kleinert Society Clinical Reunion, in Louisville, Kentucky, October 3, 2001; at the American Association for Hand Surgery, in Cancún, Mexico, January 9 to 12, 2002; and at the VIIIth Congress of the Federation of European Societies for Surgery of the Hand, in Amsterdam, Netherlands, May 22 to 25, 2002.
Francisco del Piñal, M.D., Dr.Med.
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E-39002 Santander, Spain