Sixty-four cases of thumb and finger reconstruction using transplantation of the big toe skin-nail flap combined with the second toe or the second and third toes

The purpose of this article is to introduce the results of thumb and finger reconstruction using transplantation of the big toe wraparound flap combin ed with the second toe or the second and third toes. Between August of 1981 and December of 1998, in a series of 64 cases involving 58 patients with d igitless hands, either (1) the thumb and index fingers were reconstructed b y transplantation of a big toe wraparound flap combined with the adjacent s econd toe harvested from the ipsilateral foot; or (2) the thumb, index, and long fingers were reconstructed by transplantation of an ipsilateral big t oe wraparound flap combined with the adjacent second and third toes. The ph alanx of the new thumb was usually an iliac block. The success rate of this series was 92.2 percent. At long-term followup, the average static 2-point discrimination was less than 10 mm. The distance between the tip of the ne w thumb and the new index finger ranged from 6 to 10 cm (average, 8 cm). op position action was nimble and forceful. The patients could lift a 6- to 12 -kg weight with their reconstructed digits. All patients were satisfied wit h their new hands and were able to use them in their daily activities. The transplants for reconstructing the thumb and fingers are harvested from the same foot in a procedure known as one-foot donation. Function of the bilat eral digitless hand can be recovered with this procedure.