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Toe-to-Hand Transfers for Posttraumatic and Congenital Reconstruction in Children: Indications and Surgical Technique

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Pediatric Hand Surgery

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Abstract

Miraculous improvement in hand function can be achieved by microsurgical toe-to-hand transfers, either for children who have sustained severe trauma resulting in amputations of their thumb or fingers or for children with congenital absent digits, due to symbrachydactyly, congenital constriction ring syndrome, or transverse and longitudinal deficiencies. From the first experimental microsurgical toe-to-hand transfer performed by Buncke et al. (Br J Plast Surg 19:332–337, 1966), the procedure has subsequently evolved to minimize the harvest of tissues from the foot and to customize the appearance of the great toe similar to that of the thumb. Great toe and second toe transfers for posttraumatic reconstruction of amputations of the thumb, and single second toe, simultaneous double second toe transfers (O’Brien, Hand 10:232–240, 1978; Coskunfirat et al., Plast Reconstr Surg 115:1064–1069, 2005), and combined second and third toe transfers (Wei et al., Plast Reconstr Surg 84:651–661, 1989) for posttraumatic reconstruction of multiple digital amputations have subsequently evolved for specific indications. Indications for posttraumatic microsurgical reconstruction of the thumb and fingers in children may be classified exactly similar to the classification of congenital absent digits (Jones and Kaplan, Hand 7:391–399, 2012; Jones and Clune, Hand 11:77, 2016). The optimal age for performing a toe transfer to reconstruct a congenital hand difference has not been defined. Generally, the earlier that a toe transfer is performed, the better the chance of cortical integration. Preoperative counseling of the parents with the opportunity to meet and speak with other families and children who have undergone a toe transfer is absolutely vital.

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  1. Department of Hand Surgery and Rehabilitation, San Giuseppe Hospital IRCCS MultiMedica, Milan University, Milan, Italy

    Chiara Parolo

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  1. Neil Jones
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  2. Chiara Parolo
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Correspondence to Chiara Parolo .

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  1. Department of Hand Surgery and Rehabilitation, S. Giuseppe MultiMedica Hospital, Milan University, Milano, Italy

    Giorgio Pajardi

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Jones, N., Parolo, C. (2023). Toe-to-Hand Transfers for Posttraumatic and Congenital Reconstruction in Children: Indications and Surgical Technique. In: Pajardi, G. (eds) Pediatric Hand Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-30984-7_31

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  • DOI: https://doi.org/10.1007/978-3-031-30984-7_31

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