Replantation of the great toe: review of 20 cases

Although great toe loss represents not only disruption of external body integrity but also a functional defect with possible psychological consequences, only a few publications concerning great toe replantation have been reported in the literature. The purpose of this study was to present the authors' experience with great toe replantation.

The authors retrospectively reviewed 20 cases in which replantation or revascularization of the great toe was attempted. Clinical factors, such as the patient's age at the time of surgery, injury level, mechanism, amputation type, associated injury, and intraoperative or postoperative complications were recorded. A Fisher's exact test was used to determine which clinical factor revealed statistical differences for the survival of replanted toes.

The overall survival rate was 55 percent. The main cause of failure was arterial insufficiency, and vasospasm played the leading role. Although the subgroups containing children, incomplete amputation, and no involvement of the lateral toes showed better survival rates, the difference was not statistically significant. When complete amputation of great toes was associated with injuries of the lateral toes, the survival rate was significantly decreased compared with the other cases (p < 0.05).

The goal of great toe replantation is to preserve the integrity of the metatarsophalangeal joint. The authors emphasize that great toe replantation should be restricted to traumatic amputations in children and incomplete amputations in adults, especially at the level proximal to the interphalangeal joint. Complete amputation of the great toe with injuries of the lateral toes is a poor prognostic factor for the survival of replanted toes.