title: Immediate toe-to-hand transfer in acute hand injuries: overall results, compared with results for elective cases.
abstract: In the past 5 years, 25 mutilated digits were reconstructed with immediate toe-to-hand transfers after acute hand injuries, for 21 patients. The overall results of the immediate toe-to-hand transfers were evaluated and compared with the results of 65 elective procedures performed during the same period by the same surgeon. There were 15 cases of great toe-to-hand transfer for thumb reconstruction, two cases of second toe transfer for index finger reconstruction, and four cases of simultaneous two-toe transfer for reconstruction of multiple-digit amputations. Two cases (two of 25 cases, 8 percent) were successfully salvaged with emergency reexploration. The incidences of emergency reexploration and postoperative infection were not significantly different from those for elective toe-to-hand transfer cases. The duration of industrial insurance coverage was much shorter than for elective cases, averaging 225 days (p < 0.001). Approximately 44 percent of the patients maintained their original jobs after immediate toe-to-hand transfer. The subjective satisfaction self-assessment scores of aesthetic appearance and function for the newly reconstructed thumb averaged 80 and 88 (of a total score of 100), respectively. Although satisfaction was lower than for elective reconstruction (p < 0.001), it was higher than for reconstruction of other digits. The donor-site appearance after great toe harvesting was mostly unsatisfactory. Immediate toe-to-hand transfer provides many advantages over the elective procedure in acute hand injuries, including single-stage reconstruction, shortened convalescence, early return to work, and socioeconomic efficiency. Because there were no significant differences in the success rates, frequencies of complications, or ultimate functional results, immediate toe-to-hand transfer is a safe and reliable procedure that is indicated for specific cases of acute digital amputation.
authors.affiliation: Kim and Woo's Institute for Hand and Reconstructive Microsurgery, Hyundae General Hospital, Taegu, Korea. handwoo@hotmail.com
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Woo
authors.forename: Joo-Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Seul
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017558:Elective Surgical Procedures; D005260:Female; D005383:Finger Injuries / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013997:Time Factors; D014034:Toes / Q000637:transplantation*