Toe Transfers Outperform Replantation after Digit Amputations: Outcomes of 126 Toe Transfers

Area of Science:

• Microsurgery
• Reconstructive Surgery
• Functional Outcomes Assessment

Background:

• Digital amputation traditionally assumes replantation as the gold standard.
• This study investigates functional outcomes of toe transfers versus digital replantations.
• Identifies physical variables that enhance functional outcomes post toe transfer.

Purpose of the Study:

• To compare functional outcomes of toe transfers against digital replantations.
• To determine if toe transfers can match or exceed the function of replanted digits.
• To identify predictors of improved functional outcomes after toe transfer surgery.

Main Methods:

• A cohort of 126 toe transfers across 75 patients was analyzed.
• A comparison group of 96 digital replantations from 52 patients was utilized.
• Validated patient-reported outcome measures (PROMs) including the Michigan Hand Questionnaire (MHQ), SF-36, and Foot Function Index (FFI) were primary and secondary outcomes.

Main Results:

• Toe transfers demonstrated significantly superior Michigan Hand Questionnaire (MHQ) scores (75.7) compared to digital replantation (55.0).
• SF-36 scores were also higher for toe transfers (55.79) versus replantation (53.22).
• Key factors influencing MHQ scores post toe transfer included 2-point discrimination, range of motion, grip strength, and SF-36 scores.

Conclusions:

• Toe transfers outperform digital replantations in functional outcomes based on validated PROMs.
• These findings necessitate a re-evaluation of current digital amputation treatment protocols.
• The study supports the integration of elective toe transfer surgery into standard healthcare frameworks.