Multiple toe transplantations to reconstruct three amputated neighbouring distal fingers by heat press injury--a case...

Heat press injury to the finger results in severe damage. When it is difficult to recover the function in the damaged finger, amputation may be unavoidable. We present a case of three heat press-injured neighbouring fingers reconstructed by multiple toe transplantations. All transplanted toes survived successfully. Two-point discrimination was 9, 10 and 7 mm in the index, middle and ring finger, respectively. The overall motion of the proximal interphalangeal (PIP) joint was as follows: 30/130 degrees, 30/75 degrees and 30/105 degrees at the index, middle and ring finger. The distal interphalangeal (DIP) joint presented a claw deformity of 110 degrees, 65 degrees and 65 degrees. The ability to perform different kinds of pinches was judged fully satisfactory. We have found that toe transplantation is a good option for reconstruction of multiple amputated fingers by heat press injury. In our case, it was difficult to decide on the degree of debridement. Indeed, the reconstructed middle finger unfortunately developed secondary osteoarthritis as a result of the original heat press injury to the bone. Some may have preferred to sacrifice the joint, however, since the patient is young and highly motivated towards rehabilitation, we opted to preserve the PIP joint in the hope of providing superior function. Our principle is that great efforts should be afforded to preserve viable tissues during initial debridement if we plan to perform toe transplantation.