Posttraumatic reconstruction of the hand--a retrospective review of 87 toe-to-hand transfers compared with an earlier report

Abstract

Purpose: The purpose of this study was to retrospectively review the results of 87 toe-to-hand transfers performed in 73 procedures, compare them to the report published by the senior author in 1983, and confirm the hypothesis that results of toe-to-hand transfers at our center have improved over time.

Methods: The results of 87 toe-to-hand transfers performed between 1981 and 2001 were reviewed and compared with the results of 54 toe-to-hand transfers performed between 1974 and 1980. The measured parameters were type of reconstruction performed, anticoagulation therapy, vascular patency, frequency of secondary surgery, and strength of thumb reconstructions.

Results: In the recent time period, 11% of the procedures had complications with revascularization of the transferred digit, and long-term survival was seen in 98% of the toe-to-hand transfers. This is a significant improvement over earlier results, in which 33% of the cases had some microvascular compromise and the survival of grafts was lower (91%). Pinch strength for thumb reconstructions improved, and the number of secondary surgeries performed dropped, but neither of these parameters reached a significant level. Toes used for reconstruction changed, with an 18% decrease in use of big toe for thumb reconstruction and a similar increase in use of the second toe. For non-thumb digital reconstructions there was a 60% decrease in use of second and third toe combined, whereas use of the second toe alone increased similarly.

Conclusions: This study showed reduction of the incidence of vascular compromise compared to the previous report. Improved strength of thumb reconstructions and reduced need for secondary surgery was also displayed. These findings are likely attributed to refinements in reconstructive procedures and operative techniques.

Type of study/level of evidence: Therapeutic IV.