Toe Transfers in Mutilated Hands: Technical Considerations To Get Good Outcomes

Area of Science:

• Orthopedic Surgery
• Microsurgery
• Hand Reconstruction

Background:

• Severe hand injuries often result in loss of prehensile function.
• Restoring hand function requires advanced reconstructive techniques.

Purpose of the Study:

• To outline the principles and preferred techniques for microvascular toe transfers in severe hand mutilations.
• To detail the prerequisites and surgical considerations for successful toe transfers.

Main Methods:

• Utilizing microvascular toe transfers for hand reconstruction.
• Employing radical debridement and primary wound healing.
• Preferred soft tissue coverage with a pedicled groin flap.
• Preserving the metacarpophalangeal joint and first web space.
• Performing staged toe transfers for complex cases, prioritizing thumb reconstruction.

Main Results:

• Successful restoration of prehension is achievable with meticulous surgical technique.
• Primary toe transfer is effective for isolated thumb loss.
• Staged reconstruction, starting with the thumb, yields optimal outcomes for multiple digit loss.
• Great toe transfer is suitable for thumb reconstruction in extensive palm and finger loss.

Conclusions:

• Microvascular toe transfer is a viable option for severe hand mutilations.
• Careful surgical planning, including flap selection and joint preservation, is crucial.
• High-quality tendon and nerve repair, coupled with diligent hand therapy, ensures functional recovery.