Reconstruction of a pinch through transfer of a single toe. Survey on five cases

A carpal hand, traumatic or congenital, is a challenge to the reconstruction of a useful pinch. Before the microsurgical era, the only possibility was the Krukenberg operation. But it gives an ugly appearance to the forearm, hence its use is generally limited to bilateral amputations on blind patients. Besides, one should also remember that it deprives the patient of the carpal joint. The authors present five cases of reconstruction by transfer of a single toe, the second one. There was no vascular failure. Three cases are successful function wise. One of the failures is due to the fact that the operation was undertaken too late; the patient never accepted the aspect of his new "hand". As for the other, in endeavouring to reconstruct a wide pinch, we set the toe too far away from the opposable element, which will necessitate another operation, in order to bring the two parts of the pinch closer to each other. The three successful cases demonstrate, however, that a good pinch can be created in one single operation: the transfer of the second toe provided a backstop is available-either steady or mobile, already existing or reconstructed-against which the transplanted toe can press.