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Aesthetic refinements in second toe-to-thumb transfer surgery
Jianyong Zhao1, Huey Y Tien, Shalimar Abdullah
1Louisville, Ky.; Cangzhou, China; and Kuala Lumpur, Malaysia From the Christine M. Kleinert Institute for Hand and Microsurgery, the Kleinert Kutz Hand Care Center, and the Department of Surgery, School of Medicine, University of Louisville, the Department of Hand Surgery, Hebei Province Medical University, and the Hand Unit, Medical Faculty, Universiti Kebangsaan Malaysia.
This study presents a modified second toe transfer technique to improve thumb reconstruction aesthetics. The procedure enhances thumb appearance and function while minimizing donor foot morbidity.
Area of Science:
- Plastic Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- Second toe-to-thumb transfer is a viable option for thumb reconstruction, offering functional benefits and reduced donor site morbidity compared to great toe use.
- However, aesthetic outcomes are often compromised by the second toe's inherent features: a narrow neck, bulbous tip, and short nail.
Purpose of the Study:
- To present a modified second toe transfer technique designed to improve the cosmetic appearance of the reconstructed thumb.
- To evaluate the functional and aesthetic outcomes of this modified procedure in patients undergoing thumb reconstruction.
Main Methods:
- A surgical modification involving harvesting a flap from the adjacent great toe to add bulk to the volar aspect of the second toe.
- Reshaping the toe tip through skin excisions to reduce bulbosity and excising the eponychium to enhance nail appearance.
- Application of this technique in six patients requiring thumb reconstruction.
Main Results:
- All six patients achieved improved thumb aesthetics and good functional outcomes after an average follow-up of 18 months.
- Mean two-point discrimination was 10.1 mm, with protective sensation noted in the transferred flaps.
- Patients reported high satisfaction with the aesthetic results, with one case experiencing partial flap loss.
Conclusions:
- This modified second toe transfer technique successfully addresses the aesthetic limitations of traditional methods.
- It offers patients a more cosmetically appealing thumb reconstruction while retaining the functional advantages and low donor site morbidity of second toe transfers.
