The results of toe-to-thumb transfer surgery

Abstract

Thumb makes up 50% of hand function. In the world, toe-to-thumb transfer surgery using microsurgery technique is the standard treatment for thumb reconstruction. A cohort study was performed in 30 patients from September, 2015 to March, 2018 with the age average of 28.6 (range: 7-55), and male/female rate of 25/5. Six thumb stumps without thenar muscles were reconstructed by trans-metatarsal trimmed great toe flap; 24 thumb stumps with thenar muscles were reconstructed by six trimmed great toe flaps and 18 second toe flaps. Average follow-up time was 19 months (range: 12-33 months). Primary result exhibited 100% transferred toes survived completely. Secondary results: the average of static 2-point discrimination was 13.4 mm; 5/30 (16.7%) had mal-rotation of transferred toes; 13/30 (43.3%) had tendon adhesion complication. All patients actively used the reconstructed thumbs for living and laboy activities. Four out of six thumb stump patients without thenar muscles achieved basic thumb opposition. In 24 thumb stumps with thenar muscles, the average of Kapandji thumb opposition score was 8.2; the average of grip strength and key pinch strength was 80.7 and 51.7% of the uninjured side, respectively. In conclusion, toe-to-thumb transfer surgery was safe and effective with high successful rate (100%), and exhibited good outcomes in movement and sensory restoration.