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Thumb reconstruction by micro-vascular techniques

G Foucher1, P Binhamer

  • 1SOS Main, Strasbourg, France.

International Angiology : a Journal of the International Union of Angiology
|September 1, 1995
PubMed
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Thumb reconstruction using toe transfers offers a viable solution for patients, with partial toe transfers providing superior functional and cosmetic outcomes compared to total toe transfers. This method is particularly beneficial for hand injuries.

Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Reconstructive Surgery

Background:

  • Thumb reconstruction is crucial for hand function.
  • Toe-to-thumb transfer is a reconstructive option.
  • Evaluating outcomes of different toe transfer techniques is necessary.

Purpose of the Study:

  • To review outcomes of thumb reconstruction using total or partial toe transfers.
  • To compare functional and cosmetic results of different toe transfer techniques.
  • To identify optimal techniques based on amputation level.

Main Methods:

  • Retrospective review of 63 patients undergoing thumb reconstruction via toe transfer.
  • Analysis of functional outcomes (two-point discrimination, pinch strength, range of motion).

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  • Assessment of cosmetic results and complication rates.

    • Main Results:

    • Overall failure rate was 3%.
    • Total second toe transfer resulted in 10 mm two-point discrimination, 59% pinch strength, and 30° flexion, with poor cosmesis.
    • Partial toe transfers, especially with pulp incorporation, yielded 9 mm two-point discrimination, 93% pinch strength, and better cosmesis (3.5/5).
    • Specific techniques (wrap-around, Twisted Two Toes, bipolar lengthening, custom-made) were effective for different amputation levels.

    Conclusions:

    • Partial toe transfers offer superior functional and cosmetic results for thumb reconstruction compared to total toe transfers.
    • Technique selection should be tailored to the level of metacarpophalangeal (MP) or distal amputation.
    • Toe-to-thumb transfer is a successful reconstructive strategy, particularly for otherwise normal hands.