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Thirty-Eight-Year Follow-Up After Multiple Toe-to-Hand Transfers.

M Kristine Carbullido1, Emily E Zona1, Sarah M Thornton1

  • 1Division of Plastic and Reconstructive Surgery University of Wisconsin School of Medicine and Public Health, Madison, WI.

Journal of Hand Surgery Global Online
|April 4, 2025
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Summary

Second toe-to-hand transfers offer a viable reconstructive option for pediatric hand amputations when replantation is not possible. This 38-year follow-up shows excellent long-term function and quality of life with minimal complications.

Keywords:
Hand reconstructionLong-term outcomesToe transplant

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Area of Science:

  • Plastic Surgery
  • Microsurgery
  • Pediatric Orthopedics

Background:

  • Replantation is the primary treatment for pediatric hand injuries.
  • Toe-to-hand transfer is an alternative reconstructive method when replantation is not feasible.
  • Second toe-to-hand transfer has been utilized since the 1960s.

Observation:

  • A case report details a 38-year follow-up of a patient who underwent bilateral second toe-to-hand transfer for traumatic amputations of multiple fingers.
  • The patient sustained injuries from a riding lawn mower accident.
  • Functional assessment included range of motion, grip strength, sensation, and patient-reported outcomes.

Findings:

  • The patient achieved a Disabilities of the Arm, Shoulder, and Hand (DASH) score of 0/100, indicating no functional impairment.
  • 2-point discrimination was 7 mm, signifying good sensory recovery.
  • No donor site complications were reported, and the patient maintained an active lifestyle.

Implications:

  • Toe-to-hand transplantation can restore significant hand function and improve quality of life in pediatric patients with traumatic amputations.
  • This reconstructive technique offers a long-term solution with minimal donor site morbidity.
  • The findings support the continued use of second toe-to-hand transfers in select cases of pediatric hand reconstruction.