Second toe-to-hand transplantation: A surgical option for hand amputations

BACKGROUND: The toe to hand transplantation is a method of reconstruction on the unique or multiple amputations of the fingers. It can be used the whole toe or with certain modifications as a wrap-around flap from the big toe or fingertip. It is a widely accepted option for the thumb. METHODS: It is a series of patients with amputation of one or more fingers of the hand were operated with second toe to hand transplantation. The survival was evaluated and the sensory recovery by 2-point discrimination. RESULTS: We practiced 12 transplants, 8 thumb, and 4 in other fingers. Ten were adults and two children. All transplants survived. Two patients required tenolysis flexor. The sensibility was recovered with good 2-point discrimination of 8 mm. DISCUSSION: In the more proximal finger amputations, a second toe is the most appropriate, with lower morbidity of the donor site. The rates of success are between 95 to 100%. We had a success rate of 100%. The resulting defect is in the foot is minimum when the second toe was used. The decision to use one of these techniques depends on the decision and transplant surgeon training. We always used the second toe for transfers to the hand, considering that it will be thinner than the original thumb; our patients had no complaint about the appearance. CONCLUSION: Toe-to-hand transplantation is a good technique, providing a very good aesthetic appearance and allowing the recovery of sensitivity. The defect that is created in the foot does not produce significant aesthetic and functional alterations.