title: Onycho-osteo-cutaneous defects of the thumb reconstructed by partial hallux transfer.
abstract: OBJECTIVE
  To present our experience in distal thumb amputations reconstructed by partial toe to hand transfers with special emphasis on manual workers.
  
  
  METHODS
  Twenty-five patients who experienced amputation of the thumb distal to the interphalangeal joint, excluding pure soft tissue losses, were included in the study. All but 2 were manual workers. Twenty were reconstructed within 2 weeks after injury. The other 5 were referred late. In all patients, the ipsilateral hallux was used as donor, based on the proper digital artery (18 cases), the intermetatarsal artery (6 cases), and the dorsalis pedis artery (1 case).
  
  
  RESULTS
  All transferred flaps survived. At a minimum follow-up of 1 year (range, 1-14 y), active range of motion at the interphalangeal joint was more than 55° in 23 patients. Two had an interphalangeal joint arthrodesis, 1 of them before referral. Pinch and grip were similar to the contralateral side. Two-point discrimination was normal in the dorsal oblique amputations and 7 to 11 mm in the rest. Patient satisfaction was high from a functional and aesthetic standpoint (9.5 out of 10 on a visual analog scale for both outcomes). All patients returned to work 2 to 4.5 months after the operation. Delayed donor site healing was noticed in 4 cases.
  
  
  CONCLUSIONS
  In contrast to classic teaching that recommends stump closure for cases of distal thumb amputation, we attained excellent results with partial toe transfer in manual workers. In our experience, the thumb can be restored to nearly normal with an acceptable donor site sequela. The best indication is for cases of dorsal oblique amputations, because thumb sensibility is unaffected, and for amputations where the germinal matrix is preserved, because nail regrowth occurs. Early transfer is strongly recommended.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain. Electronic address: drpinal@drpinal.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Del Piñal
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Moraleda
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
authors.forename: Guillermo H
authors.initials: GH
authors.lastname: de Piero
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
authors.forename: Jaime S
authors.initials: JS
authors.lastname: Ruas
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Galindo
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005384:Finger Joint / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006214:Hallux / Q000637:transplantation*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009262:Nails / Q000293:injuries; D052581:Pinch Strength / Q000502:physiology; D011183:Postoperative Complications / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012867:Skin / Q000293:injuries; D013524:Surgical Flaps / Q000601:surgery; D013933:Thumb / Q000293:injuries* / Q000601:surgery*; D055815:Young Adult
keywords: Microsurgery; mutilated hand; thumb amputation; toe-to-hand transfer