HS07 TOE TRANSFER – TECHNIQUES & RESULTS

Toe to thumb‐finger transfer requires the understanding of microsurgery and reconstructive technique. The success is measured by the viability of the toe and eventually recreating the function of the original loss. In harvesting of the toe, the big and second toe follows almost the same technique. Identifying the toe artery over the first web space and then dissecting proximally into the intermetatarsal artery is the best approach. To dissect the artery from proximal to distal is often fraught with many dangers. In my cases about 50% the plantar artery is dominant. Anticipation and planning of the artery length is crucial. In toe to thumb transfer the choice can be 2nd toe, total big toe, trimmed big toe or wrap around transfer. In our local populations, 2nd toe is always a good choice. First reconstruction with flap resurfacing may be necessary if the thumb amputation is very proximal. Toe to fingers transfer is usually indicated in 4 finger loss of the hand. In toe to finger transfer I prefer the two 2nd toes transfer into the middle and ring finger position. As the transferred toes can regain less that 50% of motion, the positioning of the toes should be opposable to the thumb. The concept of total reconstruction should be closely followed. Stable skeletal fixation, tendon weave technique, good nerve repair, adequate skin coverage and primary healing are important to ensure good outcome result.