By Wang Xin, MD

Although hand transplantation is an established technique, it is still not a routine treatment option for hand reconstruction. Toe transfer is still the most common method of hand reconstruction. My long-term goal is the perfect balance of hand reconstruction and foot morbidity in toe-to-hand transfer.

The donor foot morbidity is unavoidable when performing the toe-to-hand transfer. It would be more significant in the case of multiple toes transfer. However, it is essential to reconstruct a hand without severe damage to the donor foot. I used a variety of free perforator flaps to reconstruct the donor foot after toe transfer in a single stage in the past decade. Through follow-up, I found that the microsurgical reconstruction of the donor foot has the following advantages.

Firstly, surgeons could harvest enough tissue from the donor foot to reconstruct fingers with better shape and function without worrying about the complications of skin graft. Secondly, the skeleton integrity and function of the donor foot could be preserved to the maximum, which is essential for patients’ prolonged and unrestricted daily activity. Thirdly, patients could regain a functioning finger with no amputation of either toe, whose digit and toes are reconstructed with twisted toe flap and chimeric osteocutaneous SCIP, respectively.  

Here, I share a case (Fig. A-F). The patient’s thumb was reconstructed with the twisted toe flap, and both of his donor toes were salvaged by the chimeric osteocutaneous SCIP, of which the vascularized bone was fixed in the skeleton defect of the second toe, and the cutaneous flap was used for resurfacing the skin defect of the great toe. The patient was satisfied with the outcome with no sacrificing any toe to get a near-normal reconstructed thumb, although, from a surgeon’s perspective, there is still more improvement we should do.

It is a challenge for surgeons to transfer more than one free tissue flap in a single stage to reconstruct both the hand and donor foot, and the long-term value for the donor foot function still needs more clinical evidence. However, getting a perfect hand with minimal effort will always be my goal!

Reference:
Tsu-Min Tsai, Waqar Aziz. Toe-to-Thumb transfer: A new technique. Plast Reconstr Surg. 1991, 88:149-153.

Wang Xin, M.D.
Dept. of Hand Surgery, Plastic & Reconstructive Surgery
Ningbo 6th hospital, Ningbo, China