Plea to save the great toe in total thumb reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Hand Surgery

Background:

• Thumb reconstruction is a complex challenge with varying techniques.
• Toe-to-hand transfer is a viable option for young, motivated patients without avulsion injuries.
• Traditional methods may compromise donor great toe function or cosmesis.

Purpose of the Study:

• To review and present refined techniques for thumb reconstruction.
• To highlight methods that preserve the donor great toe.
• To improve functional and cosmetic outcomes for both the reconstructed thumb and the donor site.

Main Methods:

• Review of three custom-made reconstruction techniques: modified wrap-around, bipolar lengthening, and twisted two-toes.
• Focus on avoiding sacrifice of the great toe.
• Assessment of functional and cosmetic results at the donor site.

Main Results:

• Refined custom reconstruction techniques allow preservation of the great toe.
• Improved functional and cosmetic outcomes are achievable at the donor site.
• Avoidance of using a functionally and cosmetically insufficient second toe is possible.

Conclusions:

• Custom-made toe-to-hand transfers offer superior outcomes in thumb reconstruction.
• Techniques reviewed provide options for preserving the donor great toe while enhancing function and cosmesis.
• These methods represent advancements in reconstructive surgery for thumb defects.