Second Toe Transfer for the Thumb Reconstruction

Hwang,  So Min; Ahn,  Sung Min; Lim,  Kwang Ryeol; Jung,  Yong Hui; Ryu,  Min Hee

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Journal of the Korean Society for Surgery of the Hand 2009;14(3):95-101.
Published online September 1, 2009.

Second Toe Transfer for the Thumb Reconstruction

So Min Hwang, Sung Min Ahn, Kwang Ryeol Lim, Yong Hui Jung, Min Hee Ryu

Hand and Microsurgery Center, Good Moonhwa Hospital, Busan, Korea. psasm@naver.com

Abstract

Purpose
Thumb is the most important part of the hand. That requires reconstruction as a top priority. The operative methods for thumb reconstruction have been developed variously to the microsurgical technique. For better functional and cosmetic effects of the thumb, many studies and reports on toe transfer for thumb reconstruction have been conducted. Great toe transfer for thumb reconstruction was first reported by Cobbett in 1969. Since then, the second toe transfer also has been reported by Dongyue in 1979. Author report about advantages and disadvantages of the second toe transfer for thumb reconstruction. MATERIALS AND METHODS: The second toe transfer had been conducted transfer for nine patients from March 1998 to February 2007. The patient's age ranged from 18 to 52, averaging 30 years old. The levels of defect were classified as two proximal portion of proximal phalanx,five metacarpo-phalangeal joints, and two distal portion of metacarpal bone. The causes of thumb defect were classified as six trauma, two electrical burn, and one malignant tumor cases. The results were evaluated with sensation and strength the reconstructed thumb, cometic effect of recipient site, aesthetic effects at donor sites, and gait problem, at mean 32 months after the operation.

Results
After the second toe transfer, the reconstructed thumb's sense was measured as average 8.2 mm at 2 point discrimination test and it's pinching power measured average 81.7% compared to normal thumbs. The degree of cosmetic satisfaction of both donor & recipient sites appeared at 3.4 and 4.7, respectively.

Conclusions
When choosing an operative method for the thumb reconstruction, we have to consider functional and cosmetic effect as well as the socio-cultural background. If we apply the second toe transfer according to the amputation level of the thumb, it would be a good satisfying operative method.

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