Immediate partial great toe transfer for the reconstruction of composite defects of the distal thumb.
BACKGROUND
Thumb defects distal to the interphalangeal joint do not cause any disability; therefore, any consideration to reconstruct the thumb is governed by the lifestyle and cultural background of the patient. This study presents the excellent results achieved by immediate partial great toe-to-hand transfer to reconstruct acute composite defects of the distal thumb.


METHODS
Fifty-three patients with amputation or crush injury of the distal thumb who underwent partial great toe-to-hand transfer at the authors' institute over an 11-year period were reviewed. Based on the amputation level of the distal thumb, the authors classified the injuries into three groups. Operative techniques used were osteo-onychocutaneous flap with partial or whole toenail from the great toe and partial great toe transfer with arthrodesis of the interphalangeal joint. Overall results were evaluated in terms of success rate, incidence of emergency reexploration, and number and type of secondary operation. Static two-point discrimination, range of motion, pinch strength, and subjective satisfaction were also evaluated.


RESULTS
The success rate of immediate partial great toe-to-hand transfer was 100 percent. The incidence of inflammation and the reexploration rate were not significantly different from those in previously reported articles. In 35 cases where postoperative follow-up was possible, static two-point discrimination, total active range of motion, and pinch strength were generally excellent and the majority of the patients were satisfied with the final outcome.


CONCLUSIONS
Immediate reconstruction with partial great toe transfer is an excellent option for reconstruction of composite defects of the distal thumb, not only for aesthetic reasons but also for functional purposes.
Woo
Sang-Hyun
SH
Kim & Woo's Institute for Hand and Reconstructive Microsurgery, Hyundae General Hospital, Daegu, Korea. handwoo@hotmail.com
Lee
Gi-Jun
GJ
Kim
Kyung-Chul
KC
Ha
Sung-Han
SH
Kim
Joo-Sung
JS
D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D001174:Arthrodesis; D003286:Contracture / Q000601:surgery; D004630:Emergencies; D004954:Esthetics; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009262:Nails / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D016038:Skin Transplantation; D013524:Surgical Flaps; D013933:Thumb / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods; D014034:Toes / Q000637:transplantation*; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic; D016896:Treatment Outcome