[Toe-to-hand transplantation for thumb and finger reconstruction]

Reconstruction of missing thumbs or fingers remains one of the most demanding challenges in hand surgery. Over the past century, toe-to-hand transplantation has evolved from early experimental pedicled transfers into a highly refined microsurgical procedure, now widely regarded as the "gold standard" for restoring hand function. This article reviews the historical and technical development of toe transplantation-from Nicoladoni's pioneering concepts in the late 19th century, through Dr. YANG Dongyue's landmark second-toe transfer performed in 1966, to contemporary Chinese contributions such as the "total-shape reconstruction" paradigm. Modern surgical practice incorporates individualized strategies and advanced techniques, including Dr. GU Yudong's supplemental vascular-supply design and Dr. CHENG Guoliang's dual-pedicle bridging method, which collectively enhance functional recovery, aesthetic outcomes, and reliability. Emerging innovations such as three-dimensional-printed osseous scaffolds, artificial intelligence-assisted surgical planning, and tolerance-oriented transplant engineering are further driving the field toward greater precision, reduced morbidity, and improved long-term results.