title: Further developments in the twisted-toe technique for isolated thumb reconstruction: our method of choice.
abstract: BACKGROUND
  Posttraumatic loss of the thumb is devastating. Toe-to-hand transfer is considered the criterion standard of reconstruction but is associated with donor-site issues. The twisted-toe technique uses parts from the great toe and the second toe, which allows for almost anatomical restoration of the donor foot. The authors present their experience and technical modifications of this method.
  
  
  METHODS
  Between January of 2003 and November of 2011, 18 patients suffering from loss of thumb because of a variety of indications were treated with the authors' modification of the twisted-toe technique. The neothumb was constructed with a partial onychocutaneous flap from the great toe and an osseotendinous flap from the second toe.
  
  
  RESULTS
  Of 18 transplanted twisted-toe flaps, 17 survived completely (5.6 percent flap loss rate). Similarity of the reconstructed thumb compared with the healthy side was very acceptable in all cases. All patients in whom the procedure was successful were able to use the neothumb in daily life without constraints. Reconstruction of the donor site yielded very acceptable outcomes with a distinct reduction in morbidity and disfigurement compared with conventional toe harvest.
  
  
  CONCLUSIONS
  The modified twisted-toe technique is the authors' preferred choice of thumb reconstruction. It allows the reconstructive surgeon to construct a very natural-appearing neothumb with good stability and grip force. In addition, it eliminates many of the donor-site problems associated with pure great toe harvest, by recreating a "neo-great toe" at the donor foot. Although the procedure is more complicated and time-consuming compared with single toe harvest, the authors firmly believe that this extra effort takes thumb reconstruction to a next level.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Wels and Linz, Austria; and Vysoke nad Jizerou, Ceske Budejovice, and Brno, Czech Republic From the Department of Plastic and Reconstructive Surgery, General Hospital Linz; maz - Microsurgical Training and Research Center; Klinikum Wels-Grieskirchen, Hand Surgery Center; the Department of Plastic Surgery, General Hospital Ceske Budejovice; and the Department of Burns and Reconstructive Surgery, University Hospital Brno.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kempny
authors.forename: Jiri
authors.initials: J
authors.lastname: Paroulek
authors.forename: Vladimir
authors.initials: V
authors.lastname: Marik
authors.forename: Pavel
authors.initials: P
authors.lastname: Kurial
authors.forename: Bretislav
authors.initials: B
authors.lastname: Lipovy
authors.forename: Georg M
authors.initials: GM
authors.lastname: Huemer
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000637:transplantation; D009788:Occupational Therapy; D011182:Postoperative Care; D011183:Postoperative Complications / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods; D017768:Skin, Artificial; D013524:Surgical Flaps / Q000601:surgery*; D013933:Thumb / Q000293:injuries* / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014034:Toes / Q000637:transplantation*; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult