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Great Toe Transplantation.
Antonio J Forte1, Karla C Maita1, Ricardo A Torres-Guzman1
1Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida.
Seminars in Plastic Surgery
|December 23, 2022
Summary
Thumb amputation causes significant disability, but great toe transplantation offers superior reconstruction. This procedure restores hand function, pinch, and aesthetics, making it the gold standard for thumb reconstruction.
Area of Science:
- Orthopedic surgery
- Hand surgery
- Microsurgery
Background:
- Thumb amputations lead to severe hand dysfunction, impacting 40% of hand function and incurring substantial societal costs.
- Replantation is ideal for thumb loss, but alternative reconstruction methods are necessary when it's not feasible.
Purpose of the Study:
- To evaluate great toe-to-hand transplantation as a reconstructive option for thumb amputations.
- To compare the functional and aesthetic outcomes of great toe transplantation with other thumb reconstruction techniques.
Main Methods:
- Review of existing literature on thumb reconstruction techniques.
- Comparative analysis of functional outcomes (grip strength, pinch, range of motion, sensibility) and aesthetics.
- Assessment of donor site morbidity associated with great toe harvesting.
Main Results:
- Great toe-to-hand transplantation provides superior functional and aesthetic results compared to osteoplastic reconstruction, pollicization, second toe transplantation, and prostheses.
- This method effectively restores pinch, strength, and hand aesthetics.
- Donor site morbidity is generally well-tolerated.
Conclusions:
- Great toe-to-hand transplantation is the preferred reconstructive method for thumb amputations when replantation is not possible.
- It offers the best balance of functional restoration, aesthetic outcome, and acceptable donor site morbidity.
- Toe-to-thumb transplantation is considered the gold standard in thumb reconstruction.
