Metacarpal Hand: Classification and Guidelines for Microsurgical Reconstruction with Toe Transfers

Abstract

Metacarpal hand refers to the hand that has lost its prehensile ability through amputation of all fingers with or without amputation of the thumb. Functional restoration can be achieved by a wide variety of microvascular toe transfer techniques. When deciding which procedure should be used, careful consideration must be given to the level of amputation of the fingers as well as the functional status of the remaining thumb. In this article we propose a classification for the various patterns of the metacarpal hand along with guidelines for selection of the proper toe transfer procedure.

Great toe transplant versus thumb replant for isolated thumb amputation: Critical analysis of functional outcome

“…10 When attempting to replant multiple digits, the thumb should be replanted first. 38,39 Simultaneous transplantation of two toes to the hand in cases of multiple amputation has been shown to be both time-and costeffective.…”

Immediate Toe-to-Hand Transfer in Acute Hand Injuries: Overall Results, Compared with Results for Elective Cases

“…This may cause increased donor-site morbidity. In elective cases, primary coverage with recruited tissue, such as an abdominal flap, provides redundant soft tissue before toe transfer, 16 allowing the amount of tissue transferred from the toe donor site to be minimized. In some cases of elective toe transfer, dissection is limited to a short pedicle, to prevent scars on the recon- structed fingers.…”

“…The great toe was harvested from the left foot and the second toe was harvested from the right foot. In cases of a type A metacarpal hand, 16 which is a metacarpal hand with a normal thumb, bilateral second toe or combined second and third toe transfers were used, according to the interdigital web space and the level of amputation. 17,18 …”

Second-Toe Transfer for Traumatic Thumb Amputation in Children Under 5 Years

“…Multiple reports have been published making reference to thumb reconstruction with digital transfers, where excellent appearance and function were achieved. [26][27][28][29][30][31][32] Reports of digital transfers in children are uncommon when traumatic amputation is the etiology, 1,2 most series show children's reports with both congenital and traumatic amputations. In all reports the average age is over 5 years, and several reports include adolescents.…”