LS Webb, JL Dolph. Extra-anatomic microvascular second toe transfer for creation of a helper hand -a long-term follow-up. Can J Plast Surg 2008;16(2):92-94.Mutilating hand injuries can significantly alter a patient's life. Return to work and daily activities remain the ultimate goal. A case report and long-term follow-up of a patient who caught his hand in a generator fan at work is presented. He sustained an injury that left him with a wrist and metacarpal stump. When prostheses failed, an extraanatomic second toe transfer was used to produce a functional distal extremity. This transfer allowed the patient to return to his job and was surprisingly durable, resulting in a useful helper hand for 15 years.Key Words: Helper hand; Metacarpal stump; Second toe transfer Greffe microvasculaire extra-anatomique du deuxième orteil pour la création d'une main auxiliaire : Suivi à long terme Les mutilations de la main peuvent bouleverser considérablement la vie des patients. Le retour au travail et la reprise des activités normales restent les objectifs ultimes. On présente ici un rapport de cas et de suivi à long terme d'un patient qui s'est coincé la main dans un ventilateur de généra-trice. Il a subi un traumatisme qui ne lui a laissé que le poignet et un moignon métacarpien. Après l'échec des prothèses, une greffe extraanatomique du second orteil a été utilisée pour reconstruire un membre distal fonctionnel. Cette transplantation a permis au patient de retourner au travail et la greffe a tenu étonnamment longtemps. Il a ainsi bénéficié d'une main auxiliaire utile pendant une durée de 15 ans. N onanatomic toe transfer has been previously discussed for hand reconstruction (1,2). Devastating hand loss can sometimes be successfully treated with hand prostheses (3,4); however, some patients cannot or will not use or tolerate such appliances. In these patients, extra-anatomic toe transfer can produce a functional distal extremity and allow the patient to return to work. We present a case and 15-year follow-up of an extra-anatomic microvascular second toe transfer for creation of a helper hand. CASE PRESENTATIONIn January 1991, a 42-year-old right-handed man caught his left hand in a generator fan at work. He was noted to have a devastating crush/degloving injury to the left hand. Multiple small parts were brought in but were not replantable. The soft tissue injury started at the level of the wrist crease and extended distally. Denuded carpals and metacarpals were left. Debridement of devitalized tissues and split-thickness skin graft coverage resulted in a wrist and metacarpal stump (Figure 1). A prosthesis was tried, but the patient did not tolerate the appliance. The patient was deemed an appropriate candidate for extra-anatomic free second toe transfer for creation of a helper hand. Come along grasp would be via the wrist and metacarpal stumps; pinch grasp would be via the nonanatomic free second toe transfer to distal radius.In September 1992, the patient was brought to the operating room. Using a standard two team appro...