Reconstruction of the Amputated Thumb - Spare Parts to Toe Transfer

IC 23: Reconstruction of the Amputated Thumb - Spare Parts to Toe Transfer

Moderator(s): Kyle R. Eberlin, MD

Faculty: Jeffrey B. Friedrich, MD, Yu-Te Lin, MD, FACS, Bauback Safa, MD, MBA, Kyle R. Eberlin, MD

Session Handouts Friday, September 06, 2019

74TH ANNUAL MEETING OF THE ASSH SEPTEMBER 5 – 7, 2019 LAS VEGAS, NV

822 West Washington Blvd Chicago, IL 60607 Phone: (312) 880-1900 Web: www.assh.org Email: [email protected]

All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain.

Speaker has not provided a handout for this presentation

Speaker has not provided a handout for this presentation Optimizing Toe-to-Thumb Transfer and Its Variations

Fu-Chan Wei, M. D.

Distinguished Chair Professor

Department of Plastic Surgery

Chang Gung Memorial Hospital

Chang Gung Medical College & University

Taipei, Taiwan

IC23: Reconstruction of the Amputated Thumb - Spare Parts to Toe Transfer

ASSH, September 5-7, 2019. Las Vegas.

Author has nothing to declare.

Key messages

-Toe-to-thumb transfer yields the best functional and aesthetic results in thumb reconstruction.

-Success of toe-to-thumb transfer depends on optimal initial care, fulfilling the followings:

1-maintainance of maximal residual function.

2- Avoidance of excessive shortening of: Skeleton especially a mobile M.P., or I.P.

joint, tendons, or neurovascular bundles.

3-Avoid use of local flap in the hand.

4-Uncomplicted wound healing.

-Toe variants from the great toe include:

1-Total great toe, 2- Wrap-around, 3-Trimmed great toe, 4-Twist great toe.

-Optimizing thumb reconstruction with free toe transfer depends on optimization of appearance and size match with the thumb, length and position of the transferred toe, and uneventful healing of the donor site with maintenance of foot span.

Pearls

-Retrograde dissection at the webspace is the single most important technique for toe harvest.

-Total great toe is most suitable for:

1-Thumb amputation at M.P. joint, 2-Severe associated hand injury, 3-Acceptable size

match.

-Trimmed great toe is most suitable for:

Same indications as total great toe, but with no acceptable size match, or appearance

matters.

-Great toe wraparound is most suitable for:

1-Thumb skin sleeve avulsion with intact skeleton and tendons, 2-Thumb amputation

distal to I.P. joint.

-Lesser toe transfer is an alternative toe transfer indicated in:

1-Children, 2-Patient with sizable second toe, 3-Patient intolerant great toe loss, 4-

Patient less concerned hand function and appearance.

-Clawing of the lesser toe is not uncommon, it can be prevented by:

1-Tight extensor repair, 2-Temporary pinning of PIPJ & DIPJ, 3-Sustained use of

splint, 4-Modifiend extensor tendon transfer.

-Secondary procedures after toe transfer maximizes function and appearance, and include:

1-Scar revision, 2-Pulp-plasty, 3-nail reduction can be performed but not

recommended.

Reference

1. Wei FC, Chen HC, Chuang CC, Chen SH. Microsurgical thumb reconstruction with

toe transfer: selection of various techniques. Plast Reconstr Surg. 1994

Feb;93(2):345-51; discussion 352-7.

2. Wei FC, Silverman RT, Hsu WM. Retrograde dissection of the vascular pedicle in

toe harvest. Plast Reconstr Surg. 1995 Oct;96(5):1211-4. PubMed PMID: 7568502.

3. Wei FC, Chen HC, Chuang DC, Jeng SF, Lin CH. Aesthetic refinements in toe-to-

hand transfer surgery. Plast Reconstr Surg. 1996 Sep;98(3):485-90. PubMed

PMID: 8700986.

4. Chung KC, Wei FC. An outcome study of thumb reconstruction using

microvascular toe transfer. J Hand Surg Am. 2000 Jul;25(4):651-8.

5. Lin YT, Loh CYY, Lien SH, Lin CH, Wei FC. Simultaneous Stiles-Bunnell Tendon

Transfer Enhances Intrinsic Function of Second-Toe Transplantations. Plast

Reconstr Surg. 2017 Dec;140(6):1229-1234.

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