Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer

When replantation of an avulsed/amputated thumb is not feasible, toe-to-hand transfer may be considered as a reconstructive option in appropriately chosen patients. Although selection criteria are purposefully restrictive, immediate one-stage transfer, as opposed to a delayed procedure, provides many advantages. Primary reconstruction reduces hospitalization and operative and recovery time. It also may expedite return of function and allow patients to return to work sooner. The ability of the patient to undergo extensive microvascular reconstruction at the time of injury, the psychological preparation required, and the need to understand potential risks are important factors to consider.

In the past 5 years, six patients suffering thumb amputation underwent immediate great toe-to-hand transfer. The overall results of these thumb reconstructions were evaluated retrospectively with regard to function, outcome, length of stay, complications (e.g., infection, contracture, reexploration), and time to return to work/normal activity. The authors calculated objective and subjective scores with which to quantify patient satisfaction and clinical success.

All of the authors' patients were laborers who suffered work-related avulsion-amputations. No complications were reported during initial hospitalization, lasting an average of 12 days. Donor-site morbidity was minimal.

The data suggest that thumb reconstruction using great toe transfer can be safely and reliably performed during the initial presentation in selected patients. The economic and therapeutic advantages should be weighed against the risks associated with this approach when evaluating thumb avulsion-amputations.