Functional outcomes of post-traumatic metacarpal hand reconstruction with free toe-to-hand transfer

INTRODUCTION: We present the functional outcomes of microvascular toe transfer to reconstruct the post-traumatic metacarpal hand deformity. Twelve toe transfers were successfully carried out in 11 patients. MATERIALS AND METHODS: In each patient, the level of injury was classified according to the Wei classification system. Functional outcome was measured in seven patients using the Tamai score. Additional objective tests of function were carried out in three patients, including the Jebsen test, grip strength, pinch strength, web opening, static and moving two-point discrimination and Semmes–Weinstein monofilament testing. OBSERVATION AND RESULTS: The average Tamai score was 69 (range 60–83.5). Six patients achieved ‘good’ outcomes and one patient, with a double toe transfer, an ‘excellent’ outcome. The average follow-up time was 43 months (range 10–148 months). CONCLUSION: This study shows how even a single toe transfer can restore useful function to a hand that has otherwise lost all prehensile ability.