Toe-to-finger transfer for post-traumatic reconstruction of the fingerlesshand

Objective: To assess the utility of toe-to-finger transfers (TFTs) for post -traumatic reconstruction of the fingerless hand. Design: A case series. Se tting: A regional trauma centre. Patients: Eight men, mean age was 36 years (range from 25-59 yr), who had lost all the fingers from a hand due to a c rush-degloving injury (6 patients), frostbite (1 patient) or a burn injury (1 patient). Intervention: TFT. Twelve TFTs were cone and the mean time fro m injury to reconstruction was 17.2 months. Main outcome measures: Objectiv e (range of motion, moving 2-point discrimination) grip strength, key pinch , Jebsen-Taylor hand assessment, return to work) and subjective (activities of daily living and a questionnaire) measures. Results: Eleven of the 12 t ransfers survived. Six of the 7 in whom the transfer was successful were av ailable for follow-up (mean 45 mo). Range of motion was 10 degrees at the d istal interphalangeal joint, 18 degrees at the proximal interphalangeal joi nt and 59 degrees at the metacarpophalangeal joint. Sensation was protectiv e in all. Grip strength and key pinch were 26.1% and 70.2% of the contralat eral hand respectively. Jebsen-Taylor assessment indicated that basic activ ities were possible but slowed. All 6 patients returned to work and could p erform 92.6% of the activities of daily living unassisted. Hand and foot sy mptoms were mild, Two-thirds were appearance conscious, 5 of the 6 went on to altered vocations and all reported overall satisfaction as high. Conclus ion: This study supports TFT for reconstruction of the fingerless hand in t hat, although transferred toe function may be poorer than a normal finger, the hand is restored to a useful, sensate and versatile functional unit, su ch that global hand and patient function, as well as patient satisfaction, are very good.