Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation

Abstract

Background Microsurgical toe-to-hand transfer is a gold standard when it comes to repairing a thumb defect. Great toenail flap, thumbnail valva flap, free great toe, and second toe transplantation are the common methods in thumb reconstruction. Second toe transplantation achieves good function, but poor esthetics. Great toe transplantation achieves better esthetics, but hindered walking, due to the foot’s loss of the great toe and moreover suboptimal thumb function. It is difficult to maintain both functional and esthetic satisfaction in thumb reconstruction. Methods We experimented with three different methods of toe to hand transfer. From October 2009 to July 2019, 30 patients with traumatic thumb defects received one of 3 different kinds of thumb reconstruction in our clinic according to their level of amputation. Divided evenly into three groups of ten, group one received a great toe transplantation, group two received a second toe transplantation, and group three received a combined great toenail flap and second toe phalanx transplantation. Each of the patients’ thumbs had different levels of amputation at the metatarsophalangeal joint (MPJ) or distal interphalangeal joint (DIPJ). Results One patient suffered from a partial flap necrosis and received a groin flap to cover the defect. No other thumbs had any complications. The functional and esthetic results of both the donor and the recipient sites were satisfactory. Results show that, for patients with traumatic thumb defects, the combined transfer of flap and second toe phalanx was the best option. Conclusions Compared to the great toe or second toe transfer, combined free transfer of the great toenail flap and second toe phalanx achieved a substantially better functional and esthetic result in the thumb reconstruction.

Great Toe Transplantation

“…Thus, the carpometacarpal joint (CMCJ) and the MCPJ maintain their functionality, while the distal portion of the new thumb is restored using the distal interphalangeal joint (IPJ) of the toe. 19 When the amputation is located more proximal, the switching-two-toe transfer technique, a modification of the original method that combines the bony component of the second toe, described by Piñal, 20,21 is a viable option. This technique is selected to avoid harvesting the first metatarsal along with the great toe, which theoretically increases the donor site morbidity.…”

Comparison treatment of medium-sized volar fingertips defects with modified triangular neurovascular unilateral advancement flap versus digital artery dorsal perforator flap

“…Nevertheless, they have some drawbacks, including poor sensibility and need skin graft in donor site. Free toe tissue transfer [ 8 – 10 ] as a reliable treatment method with good clinical outcomes in tissue similarity, motive function, and excellent sensibility. However, its complex nature limits its application in fingertip reconstruction.…”