Toe to Hand Transfer

WHAT YOU SHOULD KNOW

Many patients ask about transplant of body parts. The word transplant actually refers to a body part such as a kidney, heart, lung, hand, or face from another genetic individual being transplanted from that other person to the patient. The problem with transplant surgery is rejection of the genetic differences that requires lifetime immune suppression medications to be consumed by the transplant patient. Those transplant drugs have dangerous side effects that often permanently harm the transplant patient. The word transfer is the correct terminology for moving a body part from one location to another within the same patient. Because the tissue is genetically the same, there is no issue of rejection. The issues are then just tissue survival and healing.

Severe hand trauma can result in amputation of one or more digits. The most elegant method to reconstruct a missing digit is to use the body part that is the most similar to it, a toe. The second toe, next door to the big toe, is the one most commonly used for reconstruction. There are two indications to consider performing a second toe to hand reconstruction. The first is when the amputation is beyond the middle joint of the finger and that joint has good motion. In this setting, good restoration of hand function can be achieved compared to an excessively short amputation.  The other indication is when the hand has lost so many digits that the minimum criteria of two fingers that can form a tripod pinch with the thumb does not exist.

The other major indication for toe to hand transfer is to reconstruct the thumb. Thumb reconstruction can be performed using either the second toe or the great toe (big toe). There are multiple factors to consider as advantages or disadvantages to using one donor compared to the other. These considerations should be individually applied to each case, with the ultimate decision by the patient according to personal preference.

MEDICAL HISTORY

Patients may have already undergone a number of surgeries before first appearing in the reconstructive microsurgery clinic. Patients should bring the typed operative reports of these other operations to be reviewed. Important details of the anatomy left behind after the former surgeries are essential in planning the upcoming reconstruction.

EXAMINATION

The location and degree of scar tissue, freedom of joint movement, and level of amputation are closely examined along with all other functions of the affected and the opposite hand.

ADDITIONAL TESTS

The most common additional test performed is to listen to the blood flowing through local arteries using Doppler technology. If important questions remain regarding the anatomy of the blood vessels left behind in the hand, it may be necessary to obtain a picture called an angiogram after injecting dye into vessels.

TREATMENT OPTIONS
  SECOND TOE TRANSFER GREAT TRANSFER
CONSISTS OF Whole or partial toe transfer Usually only partial toe transfer or combined parts with some from the second toe
FEATURES All parts needed by the finger are taken from the toe Usually used only in reconstruction of damage to the thumb
ADVANTAGES Can obtain longer transfer by taking bone from the foot level (metatarsal) Better strength, size match better (too large if not trimmed)
DISADVANTAGES For thumb reconstruction is too small and makes a weaker transfer More disturbance of walking ability proportionate to amount of tissue taken in transfer
Scroll/swipe >
RECOVERY

The small connections between blood vessels that have been sewn together can clot easily. The patient stays in the hospital for 5 days after surgery to control the environment and for close monitoring. After hospital discharge, outpatient rehabilitation begins with exercises for motion and control of swelling. The tendon connections must be moved frequently to avoid stiffness. Nerve regrowth is slow and the tips of the new digit do not gain feeling for many months. Forceful gripping and pinching activities are not allowed until bone and tendon healing has passed at least the initial 6-8 weeks.

Houston Hand and Wrist