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An outcome study of thumb reconstruction using microvascular toe transfer
1Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
The Journal of Hand Surgery
|July 27, 2000
Summary
Microvascular toe to thumb transfer significantly improves hand function, daily activities, and satisfaction for thumb amputees. This reconstructive surgery offers comparable hand strength and dexterity with minimal foot donor site issues.
Area of Science:
- Reconstructive Microsurgery
- Hand Surgery Outcomes
- Patient-Reported Outcome Measures
Background:
- Thumb amputations at the metacarpophalangeal joint significantly impair hand function and quality of life.
- Restoring thumb function is crucial for overall hand utility and patient satisfaction.
- Microvascular toe transfer is a reconstructive option for thumb loss.
Purpose of the Study:
- To evaluate the functional and patient-reported outcomes of microvascular toe to thumb transfer.
- To compare outcomes between patients who underwent toe transfer and those with unreconstructed thumb amputations.
- To assess hand function, activities of daily living (ADL), work performance, aesthetics, and patient satisfaction.
Main Methods:
- A cohort study involving 21 patients with unilateral, isolated thumb amputations.
- 16 patients underwent microvascular toe transfer; 5 did not receive reconstruction.
- Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, SF-36, Lower Limb Function Questionnaire, and hand function tests over a mean follow-up of 7.2 years.
Main Results:
- Toe transfer patients demonstrated significantly better overall hand function (effect size [ES] = 1.4), ADL (ES = 3.4), work performance (ES = 2.1), aesthetics (ES = 1.9), and satisfaction (ES = 1.1).
- Functional testing revealed comparable strength and dexterity in toe-transferred hands versus the contralateral normal hands.
- No significant difference in Lower Limb Function Questionnaire scores was observed between the toe transfer and unreconstructed amputation groups.
Conclusions:
- Microvascular toe to thumb transfer is an effective procedure for restoring thumb function after amputation at the metacarpophalangeal joint.
- The procedure leads to substantial improvements in hand function, daily living, and patient satisfaction.
- Toe transfer offers a viable reconstructive solution with minimal donor site morbidity and functional compromise.