Bilateral Metacarpal Hands: Reconstruction With 6 Toe Transfers

Area of Science:

• Orthopedics
• Hand Surgery
• Microsurgery

Background:

• Bilateral metacarpal hand injuries are exceptionally rare.
• These injuries pose the most complex reconstructive challenges in hand surgery.
• Such injuries lead to devastating functional deficits and significant psychological impact.

Purpose of the Study:

• To discuss reconstructive options for bilateral metacarpal hand injuries.
• To present long-term outcomes of a multi-stage toe-to-hand transfer reconstruction.
• To evaluate functional, gait, and psychological results in a pediatric case.

Main Methods:

• Review of reconstructive options: Krukenberg procedure, bionic prostheses, toe-to-hand transfers, hand transplantation.
• Detailed presentation of a 4-stage reconstruction in a child with bilateral metacarpal hand injuries.
• Utilized 6 toe transfers: bilateral great toe transfers for thumbs, bilateral combined second-third monobloc transfers for fingers.

Main Results:

• Reconstruction using 6 toe transfers achieved excellent functional results.
• High levels of patient satisfaction were reported post-reconstruction.
• The procedure demonstrated acceptable donor site morbidity.

Conclusions:

• Multiple toe transfers (4, 5, or 6) are a viable and effective reconstructive strategy.
• This approach yields excellent outcomes for severe bilateral metacarpal hand injuries.
• Toe-to-hand transfers provide a successful solution with manageable donor site impact.