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A systematic review of outcomes of toe-to-thumb transfers for isolated traumatic thumb amputation

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HAND

Abstract

Background

Toe-to-thumb transfer is an established procedure for reconstruction of traumatic thumb amputations. The four types of toe-to-thumb transfers are the second toe, the great toe, the wrap-around great toe and the trimmed great toe transfers. The purpose of this study is to conduct a systematic review of the literature to compare outcomes amongst different methods of toe-to-thumb transfers.

Methods

A literature search using ‘toe-to-thumb transfer’ combined with ‘thumb injury’ and ‘thumb reconstruction’ as keywords and limited to humans and the English language identified 633 studies. Studies were included in the review if they: (1) present primary data, (2) report three or more toe-to-thumb transfers for isolated complete traumatic thumb amputation between the metacarpophalangeal joint and the interphalangeal joint (both excluded) and (3) present functional outcome data.

Results

Twenty-five studies representing 450 toe-to-thumb transfers met the inclusion criteria. They included 101 second toe transfers, 196 great toe transfers, 122 wrap-around transfers and 31 trimmed toe transfers. The mean survival rate was 96.4%. No statistically significant differences could be detected between the four transfers with regards to survival, arc of motion, total active motion, grip and pinch strength and static two-point discrimination.

Conclusions

All four types of toe transfer procedures have predictably high survival rates and good patient satisfaction scores. The current data are inadequate to make any comments with regards to donor site morbidity. Till such data are available, an evidence-based recommendation for the superiority of a specific type of toe-to-thumb transfer cannot be made.

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References

  1. Adani R, Cardon LJ, Castagnetti C, Pinelli M. Distal thumb reconstruction using a mini wrap-around flap from the great toe. J Hand Surg Br. 1999;24:437–42.

    Article  PubMed  CAS  Google Scholar 

  2. Adani R, Marcoccio I, Tarallo L, Fregni U. The aesthetic mini wrap-around technique for thumb reconstruction. Tech Hand Up Extrem Surg. 2005;9:42–6.

    Article  PubMed  Google Scholar 

  3. Barca F, Santi A, Tartoni PL, Landi A. Gait analysis of the donor foot in microsurgical reconstruction of the thumb. Foot Ankle Int. 1995;16:201–6.

    PubMed  CAS  Google Scholar 

  4. Brown CJ, Mackinnon SE, Dellon AL, Bain JR. The sensory potential of free flap donor sites. Ann Plast Surg. 1989;23:135–40.

    Article  PubMed  CAS  Google Scholar 

  5. Buncke GM, Buncke HJ, Lee CK. Great toe-to-thumb microvascular transplantation after traumatic amputation. Hand Clin. 2007;23:105–15.

    Article  PubMed  Google Scholar 

  6. Chung KC, Wei FC. An outcome study of thumb reconstruction using microvascular toe transfer. J Hand Surg Am. 2000;25:651–8.

    Article  PubMed  CAS  Google Scholar 

  7. Cobbett JR. Free digital transfer. Report of a case of transfer of a great toe to replace an amputated thumb. J Bone Joint Surg Br. 1969;51:677–9.

    PubMed  CAS  Google Scholar 

  8. Doi K. Microsurgical thumb reconstruction—report of six cases with a wrap-around free flap from the big toe and an iliac bone graft. Ann Acad Med Singapore. 1982;11:225–30.

    PubMed  CAS  Google Scholar 

  9. Doi K, Kuwata N, Kawai S. Reconstruction of the thumb with a free wrap-around flap from the big toe and an iliac-bone graft. J Bone Joint Surg Am. 1985;67:439–45.

    PubMed  CAS  Google Scholar 

  10. Doi K, Hattori Y, Dhawan V. The wrap-around flap in thumb reconstruction. Tech Hand Up Extrem Surg. 2002;6:124–32.

    Article  PubMed  Google Scholar 

  11. Finseth F, Buncke HJ. Thumb and digit reconstruction: toe-to-hand microvascular composite tissue transplantation. Int Surg. 1981;66:13–8.

    PubMed  CAS  Google Scholar 

  12. Frykman GK, O'Brien BM, Morrison WA, MacLeod AM. Functional evaluation of the hand and foot after one-stage toe-to-hand transfer. J Hand Surg Am. 1986;11:9–17.

    PubMed  CAS  Google Scholar 

  13. Gilbert A. Toe transfers for congenital hand defects. J Hand Surg Am. 1982;7:118–24.

    PubMed  CAS  Google Scholar 

  14. Gu YD, Cheng DS, Zhang GM, Chen XM, Xu JG, Yang XB. Long-term results of toe transfer: retrospective analysis. J Reconstr Microsurg. 1997;13:405–8.

    Article  PubMed  CAS  Google Scholar 

  15. Gulgonen A, Gudemez E. Toe-to-hand transfers: more than 20 years follow-up of five post-traumatic cases. J Hand Surg Br. 2006;31:2–8.

    PubMed  CAS  Google Scholar 

  16. Harashina T. Analysis of 200 free flaps. Br J Plast Surg. 1988;41:33–6.

    Article  PubMed  CAS  Google Scholar 

  17. Haughey BH, Wilson E, Kluwe L, et al. Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg. 2001;125:10–7.

    Article  PubMed  CAS  Google Scholar 

  18. Huang D, Wang HG, Wu WZ, Zhang HR, Lin H. Functional and aesthetic results of immediate reconstruction of traumatic thumb defects by toe-to-thumb transplantation. Int Orthop. 2011;35(4):543–7.

    Article  PubMed  Google Scholar 

  19. Jeng C, Michelson J, Mizei M. Sensory thresholds of normal human feet. Foot Ankle Int. 2000;21:501–4.

    PubMed  CAS  Google Scholar 

  20. Jenkins M, Bamberger HB, Black L, Nowinski R. Thumb joint flexion. What is normal? J Hand Surg Br. 1998;23:196–7.

    Google Scholar 

  21. Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma. 1989;29:1086–94.

    Article  PubMed  CAS  Google Scholar 

  22. Lee CK, Buncke GM. Great toe-to-thumb microvascular transplantation. Clin Plast Surg. 2007;34:223–31.

    Article  PubMed  CAS  Google Scholar 

  23. Lee KS, Chae IJ, Hahn SB. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe: long-term follow-up of thirty cases. Microsurgery. 1995;16:692–7.

    Article  PubMed  CAS  Google Scholar 

  24. Lee KS, Park JW, Chung WK. Thumb reconstruction with a wrap-around free flap according to the level of amputation. Microsurgery. 2000;20:25–31.

    Article  PubMed  CAS  Google Scholar 

  25. Lee KS, Park JW, Chung WK. Thumb reconstruction with a wraparound free flap according to the level of amputation. J Hand Surg Am. 2000;25:644–50.

    Article  PubMed  CAS  Google Scholar 

  26. Lipton HA, May Jr JW, Simon SR. Preoperative and postoperative gait analyses of patients undergoing great toe-to-thumb transfer. J Hand Surg Am. 1987;12:66–9.

    PubMed  CAS  Google Scholar 

  27. Lister GD, Kalisman M, Tsai TM. Reconstruction of the hand with free microneurovascular toe-to-hand transfer: experience with 54 toe transfers. Plast Reconstr Surg. 1983;71:372–86.

    Article  PubMed  CAS  Google Scholar 

  28. Lowdon IM, Nunley JA, Goldner RD, Urbaniak JR. The wraparound procedure for thumb and finger reconstruction. Microsurgery. 1987;8:154–7.

    Article  PubMed  CAS  Google Scholar 

  29. Lutz BS, Wei FC. Basic principles on toe-to-hand transplantation. Chang Gung Med J. 2002;25:568–76.

    PubMed  Google Scholar 

  30. Minami A, Usui M, Katoh H, Ishii S. Thumb reconstruction by free sensory flaps from the foot using microsurgical techniques. J Hand Surg Br. 1984;9:239–44.

    Article  PubMed  CAS  Google Scholar 

  31. Morrison WA, O'Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg Am. 1980;5:575–83.

    PubMed  CAS  Google Scholar 

  32. Morrison WA, O'Brien BM, MacLeod AM. The surgical repair of amputations of the thumb. Aust N Z J Surg. 1980;50:237–43.

    Article  PubMed  CAS  Google Scholar 

  33. Morrison WA, O'Brien BM, MacLeod AM. Experience with thumb reconstruction. J Hand Surg Br. 1984;9:223–33.

    Article  PubMed  CAS  Google Scholar 

  34. Nunley JA, Goldner RD, Urbaniak JR. Thumb reconstruction by the wrap-around method. Clin Orthop Relat Res. 1985;195:97–103.

    PubMed  Google Scholar 

  35. Patradul A, Kitidumrongsook P, Ngarmukos C, Parkpian V. Microsurgical toe to thumb transplantation for traumatic thumb loss. J Med Assoc Thai. 2000;83:77–84.

    PubMed  CAS  Google Scholar 

  36. Poppen NK, Norris TR, Buncke Jr HJ. Evaluation of sensibility and function with microsurgical free tissue transfer of the great toe to the hand for thumb reconstruction. J Hand Surg Am. 1983;8:516–31.

    PubMed  CAS  Google Scholar 

  37. Ray EC, Sherman R, Stevanovic M. Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer. Plast Reconstr Surg. 2009;123:259–67.

    Article  PubMed  CAS  Google Scholar 

  38. Reigstad A, Hetland KR, Waage S, Bye K, Rokkum M. Transfer of the second toe for reconstruction of the hand after trauma. Scand J Plast Reconstr Surg Hand Surg. 1992;26:105–10.

    Article  PubMed  CAS  Google Scholar 

  39. Rosson GD, Buncke GM, Buncke HJ. Great toe transplant versus thumb replant for isolated thumb amputation: critical analysis of functional outcome. Microsurgery. 2008;28:598–605.

    Article  PubMed  Google Scholar 

  40. Sabapathy SR, Venkatramani H, Bharathi RR. Functional evaluation of a great toe transfer and the osteoplastic technique for thumb reconstruction in the same individual. J Hand Surg Br. 2003;28:405–8.

    PubMed  CAS  Google Scholar 

  41. Schweitzer G. Laxity of metacarpophalangeal joints of fingers and interphalangeal joint of the thumb: a comparative inter-racial study. S Afr Med J. 1970;44:246–9.

    PubMed  CAS  Google Scholar 

  42. Shaw SJ, Morris MA. The range of motion of the metacarpophalangeal joint of the thumb and its relationship to injury. J Hand Surg Br. 1992;17:164–6.

    PubMed  CAS  Google Scholar 

  43. Songcharoen P, Thanapipatsiri S, Mahaisavariya B, Chotigavanich C. Thumb reconstruction with a big toe microvascular wrap-around flap: a report of fifteen cases. Ann Acad Med Singapore. 1995;24:46–50.

    PubMed  CAS  Google Scholar 

  44. Stupka I, Vesely J, Hyza P, Molitor M, Kucerova K, Dvorak Z. Long term results of digital reconstruction using toe-to-finger transfers. Eur J Plast Surg. 2004;27:271–82.

    Article  Google Scholar 

  45. Tsai TM, Falconer D. Modified great toe wrap for thumb reconstruction. Microsurgery. 1986;7:193–8.

    Article  PubMed  CAS  Google Scholar 

  46. Tsai TM, McCabe S, Beatty ME. Second toe transfer for thumb reconstruction in multiple digit amputations including thumb and basal joint. Microsurgery. 1987;8:146–53.

    Article  PubMed  CAS  Google Scholar 

  47. Valauri FA, Buncke HJ. Thumb reconstruction—great toe transfer. Clin Plast Surg. 1989;16:475–89.

    PubMed  CAS  Google Scholar 

  48. Valauri FA, Buncke HJ. Thumb and finger reconstruction by toe-to-hand transfer. Hand Clin. 1992;8:551–74.

    PubMed  CAS  Google Scholar 

  49. Vitkus K, Vitkus M, Krivulin A. Long-term measurement of innervation density in second toe-to-thumb transfers receiving immediate postoperative sensory reeducation. Microsurgery. 1989;10:245–7.

    Article  PubMed  CAS  Google Scholar 

  50. Wei FC, El-Gammal TA. Toe-to-hand transfer. Current concepts, techniques, and research. Clin Plast Surg. 1996;23:103–16.

    PubMed  CAS  Google Scholar 

  51. Wei FC, Ma HS. Delayed sensory reeducation after toe-to-hand transfer. Microsurgery. 1995;16:583–5.

    Article  PubMed  CAS  Google Scholar 

  52. Wei FC, Chen HC, Chuang CC, Noordhoff MS. Reconstruction of the thumb with a trimmed-toe transfer technique. Plast Reconstr Surg. 1988;82:506–15.

    Article  PubMed  CAS  Google Scholar 

  53. Wei FC, Chen HC, Chuang CC, Chen SH. Microsurgical thumb reconstruction with toe transfer: selection of various techniques. Plast Reconstr Surg. 1994;93:345–51. discussion 52–7.

    Article  PubMed  CAS  Google Scholar 

  54. Woo SH, Kim JS, Seul JH. Immediate toe-to-hand transfer in acute hand injuries: overall results, compared with results for elective cases. Plast Reconstr Surg. 2004;113:882–92.

    Article  PubMed  Google Scholar 

  55. Xu L, Gu YD, Xu JG, Rui YJ, Shou KS. Microsurgical treatment for bilateral thumb defect: five case reports. Microsurgery. 2003;23:547–54.

    Article  PubMed  Google Scholar 

  56. Yang DY, Gu YD. The report of free second toe transfer for thumb reconstruction in 4 cases. Chin J Surg. 1977;15:1–3.

    Google Scholar 

  57. Yoshida R, House HO, Patterson RM, Shah MA, Viegas SF. Motion and morphology of the thumb metacarpophalangeal joint. J Hand Surg. 2003;28:753–7.

    Article  Google Scholar 

  58. Yoshimura M, Nomura S, Yamauchi S, Umeda S, Ueno T, Iwai Y. Toe-to-hand transfer: experience with thirty-eight digits. Aust N Z J Surg. 1980;50:248–54.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgement

Support for this study was provided in part by a Midcareer Investigator Award in Patient-Oriented Research (K24 AR053120) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (to Dr. Kevin C. Chung).

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Authors and Affiliations

  1. Section of Plastic Surgery, Department of Surgery, Chung Gung Memorial Hospital and Kaohsiung Medical Center, College of Medicine, Chung Gung University, Kaohsiung, Taiwan

    Pao-Yuan Lin

  2. Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore, Singapore

    Sandeep Jacob Sebastin

  3. Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA

    Shimpei Ono, Lillian T. Bellfi & Kate Wan-Chu Chang

  4. Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Medical Center, 1500 E Medical Center Dr, 2130 Tubman Center, Ann Arbor, MI, 48109-0340, USA

    Kevin C. Chung

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  1. Pao-Yuan Lin
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Correspondence to Kevin C. Chung.

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Lin, PY., Sebastin, S.J., Ono, S. et al. A systematic review of outcomes of toe-to-thumb transfers for isolated traumatic thumb amputation. HAND 6, 235–243 (2011). https://doi.org/10.1007/s11552-011-9340-x

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