Bilateral hand reconstruction: report of three cases

Although it has been established that a single lost hand can be reconstructed by autogenous bilateral toe transplantation, the problem of how to reconstruct bilateral hand loss still remains. The authors present a novel approach to solve this intricate problem. A big toe free skin-nail flap, along with the second digital ray or second and third digital rays, with a common vascular pedicle, is taken from the donor foot and transferred to the forearm stump by microsurgical technique, thereby creating a hand with two or three digits. Either a piece of the iliac bone or an ulna block cut during the preparation of the forearm stump is used to substitute for the lost first metacarpus and phalanges of the thumb. The operative technique is described. Three patients have undergone this procedure and have had both lost hands reconstructed. Among the six reconstructed hands, two had two digits in each and the others had three digits. One reconstructed hand failed to survive subsequent to vascular thrombosis which might have been due to degeneration and thickening of the vessel wall. Partial failure occurred in another, where the transferred big toe skin-nail flap necrosed and was replaced by a pedicled skin tube. All five surviving hands were followed up for more than one year and showed satisfactory functional recovery.