[Toe transfer to a mid-hand stump covered with abdominal skin]

Following amputation of all four fingers from the hand, the cover of the amputation site with an abdominal flap gives a hand which is functionally inferior. This paper reports our experiences of three toe transfers to such a hand in two patients, one a 22-year-old man, the other, a 50-year-old woman. In our opinion, the toe transfer will be successful if the vessels, nerves and tendons are harvested to the level of the extensor retinaculum, giving a length in excess of the skeleton of some 12-15 cm. The routing of these structures beneath the abdominal flap is done in such a way as to avoid any ischemia and therefore, infection. In the first case, these latter considerations were not fully observed and in the third postoperative week, arterial thrombosis with loss of the transfer developed, following an infection. The two other transposed digits have survived with a good functional result.