Foot morbidity following toe to hand transfers

Abstract

Toe-to-hand transfers to replace missing fingers have become a common reconstructive practice in our clinic. The purpose of this article is to evaluate morbidity of the donor site on the foot following the transfer. A group of 72 patients were assessed; 95 feet were examined post-transfers, i.e., 23 patients had transfers from both feet. The groups were arranged according to the numbers of patients as follows: group A (37 cases), second toe from one foot; group B (17 cases), second toes from both feet; group C (6 cases) with wrap-around flap; and group D (5 cases), the whole big toe. This was followed by group E (7 patients), who had the combination of the second and third toes harvested simultaneously, the great toe or wrap-around flap in combination with harvesting the second toe from the same or contralateral foot. Scar quality of the donor site, standing on tiptoe and tiptoeing, discomfort after prolonged walking, stair climbing, need to change the shoe size, and participation in special activities, such as sports and overall patient satisfaction, were evaluated. The least significant problems occurred in patients with the second toe harvested, they had minimum complaints with static loading and minor complaints with dynamic loading. Patients with the second toes harvested from both feet also had minimum complaints with static loading and minor complaints in dynamic loading. More problems were observed with both static and dynamic loading in the patients with the great-toe transfer. The biggest troubles were reported by the patients with the wrap-around flap or in case of multiple toe transfers. Only one patient from the sample had to seek medical help of a specialist due to some problems following the toe harvest. In the retrospective subjective evaluation of patient satisfaction and benefits of the operation, all patients declared that they would undergo the reconstruction again despite the problems encountered at the donor site.