Initial results of reconstructive surgery for metacarpal hand using toe transfers

Abstract

Metacarpal hand is a severe and complicated injury. The aim of this study is to share initial experiences obtained after using toe transfers to reconstruct metacarpal hands. This is a prospective, longitudinal study without a control group. A total of seven toe flaps (4 combined second and third toe flaps, 3 second toe flaps) were used to reconstruct 5 metacarpal hands in 5 patients from November 2017 to March 2019. The average follow-up was 37 months. Primary result: The survival rate of the transferred toes was 7/7. Secondary results: Tripod pinch grasp was achieved in all 5 cases; sensory recovery grade S3(+) was reached in all transferred toes. The average maximum grip span was 12.8 cm. The average foot and ankle disability index score was 95.6/100. 3/5 cases had toe crossover complications. 4/5 patients could return to their previous work. In conclusion, toe transfer surgery for functional reconstruction of the metacarpal hand was safe with a survival rate of 7/7, resulting in good recovery of both movement and sensation. Foot morbidity was minimal, with an average foot and ankle disability index score of 95.6/100.