Thumb Amputations in Children: Classification and Reconstruction by Microsurgical Toe Transfers

Area of Science:

• Pediatric reconstructive surgery
• Microsurgery
• Hand surgery

Background:

• Traumatic thumb amputations are rare in children.
• Microsurgical toe-to-thumb transfers are underutilized for pediatric thumb reconstruction.
• Traditional methods like distraction lengthening and pollicization have limitations.

Purpose of the Study:

• To report functional outcomes and complications of microsurgical toe-to-thumb transfers in children with traumatic thumb amputations.
• To evaluate the efficacy of toe-to-thumb reconstruction in pediatric patients.
• To compare outcomes with traditional reconstructive techniques.

Main Methods:

• Retrospective review of 19 children (21 amputations) undergoing toe-to-thumb transfer.
• Collected data on amputation level, toe used, vascular pedicle, transfer survival, and complications.
• Assessed opposition, sensation, growth, and functional/psychosocial outcomes using the Pediatric Outcomes Data Collection Instrument.

Main Results:

• All 21 toe transfers survived without immediate reexploration.
• Children regained pinch, grasp, and sensation.
• No gait problems were reported in donor feet.
• Excellent functional and psychosocial outcomes were observed.

Conclusions:

• Microsurgical toe-to-thumb transfer is a successful reconstructive option for pediatric traumatic thumb amputations.
• It provides length, opposition, and sensation without compromising ambulation.
• This technique should be considered an alternative to distraction lengthening and pollicization.