Report on 250 consecutive toe to finger transplants. Indications, results, failures, and new applications

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• 作者：Francisco del Pi&#241 ; al ; ^{drpinal@ono.com} ; Francisco Javier Garcí ; a-Bernal ; Carlos Thams ; Alexis Studer ; Javier Regalado
• 关键词：Amputation ; Microsurgery ; Toe-to-han
• 刊名：Revista Espa?ola de Cirug¨ªa Ortop¨¦dica y Traumatolog¨ªa (English Edition)
• 出版年：2011
• 出版时间：2011
• 年：2011
• 卷：55
• 期：4
• 页码：257-262
• 全文大小：1337 K

文摘

Purpose

Toe-to-hand transfers are an essential part of hand rehabilitation after loss of a finger. Despite this, the likelihood of failure and the hypothetical morbidity in the donor area, made this procedure not very popular among surgeons. The purpose of this paper is to present our clinical experience, highlighting the pitfalls and the new indications.

Material and methods

Between February 1995-January 2010 we performed 250 toe-tohand transfers for finger amputations. In metacarpal hands (23 cases) we transferred the hallux from one foot and the 2nd and 3rd from the other, to achieve a three-fingered (tripod) grasp. The rest of the patients had multi-digit, simple or partial amputations. In 69 the thumb was reconstructed and the rest of transfers were for finger reconstructions.

Results

Re-operation rate due to acute ischaemia was 16 % (10 % intraoperative) and the overall success rate was 98.8 % (3 failures). There was no partial necrosis in any case. Regarding the donor side, one patient was operated on due to a painful neuroma; the rest did not have complaints in the donor area.

Conclusions

In our experience toe-to hand transfers are a safe and reliable method to rehabilitate severe hand injuries. Donor site morbidity is directly related to the number of toes harvested, and is well-tolerated by the patients, especially in severe injuries.