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Updated: Mar 28, 2026

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Second Toe Transfer and "Tandem" Free Flap for Radial Hand Injuries with Thumb Loss.

R Srikanth1, D Mukunda Reddy2, R Parvathi1

  • 1Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India.

Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
|March 27, 2026
PubMed
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Articles linked to this work by shared authors, journal, and citation graph.

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Bilateral Lower Limb Injuries and the Need for Two Free Flaps: Simultaneous or Sequential.

Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India·2025
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Multiple Free Flaps and Second Toe Transfer to Salvage Grasp Function in Bilateral Complete Degloved Hands.

Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India·2025
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Role of Free Flaps in Facial Burn Reconstructions.

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Free tissue transfer for reconstruction of axillary defects: two case reports.

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Expediting venous drainage in large anterolateral thigh flaps for scalp electrical burns in India: two case reports on the use of primary vein grafts for second vein anastomosis.

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Primary Free Flaps for Coverage and Reconstruction in Acute Facial Trauma.

Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India·2023

Simultaneous free flap and second toe transfer effectively restored thumb function in eleven patients with radial hand defects. This reconstructive technique yielded useful grasp and pinch, highlighting its potential for complex hand injuries.

Area of Science:

  • Microsurgery
  • Reconstructive Surgery
  • Hand Surgery

Background:

  • Thumb loss and radial hand defects present significant reconstructive challenges.
  • Restoring thumb function is crucial for hand utility and patient quality of life.

Purpose of the Study:

  • To evaluate the efficacy of simultaneous free flap cover and second toe transfer for thumb reconstruction.
  • To assess functional outcomes and complication rates of this combined reconstructive approach.

Main Methods:

  • Eleven patients with thumb loss and radial hand defects underwent simultaneous free flap (anterolateral thigh or lateral arm) and second toe transfer.
  • Flap revascularization preceded toe revascularization, utilizing specific arterial and venous anastomoses.
  • Follow-up included functional assessment using the Kapandji score.
Keywords:
free flapsecond toe transferthumb amputationthumb reconstruction

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Main Results:

  • All patients achieved useful thumb grasp and pinch post-reconstruction.
  • The mean Kapandji score for opposition was 6 among evaluable patients.
  • One transferred toe was lost despite two re-explorations, indicating a high success rate.

Conclusions:

  • Simultaneous free flap and second toe transfer is a viable and effective method for reconstructing thumb defects.
  • This technique restores essential hand functions, improving patient outcomes.
  • Secondary procedures may be necessary to optimize functional results.