Novel technique for toe-to-hand transplantation: The fourth-toe as an alternative option for toe-to-hand transplantation for pediatric patients

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

The first toe-to-hand transplantation was done in 1898 by Nicoladoni. It was a staged procedure and the toe flap was based on a pedicle. With advancement of optical instruments and microsurgeons' skills in 1964 the first microvascular toe-to-hand transplantation on a rhesus monkey was done. The technique's development has not stopped, many authors have modified it to achieve better outcomes for both traumatic and congenital hand defects. The most commonly used toes for transplantation are first, second, and second to third toe block. Well described plantar and dorsal vascular systems for first web space vessels as well as possibility to perform successful perforator anastomosis allows us to improve toe-to-hand transplantation further. There is a paucity of studies on single fourth toe-to-hand transplantation. We performed fourth-toe transplantation for three pediatric patients (mean age, 73 mo) with congenital (n=2) and traumatic (n=1) hand defects. Common plantar digital arteries were used for blood supply to the transplanted toes. No vascular problems occurred, and all transplanted toes survived. Patients and parents are satisfied with functional and esthetic outcomes. Early podometry results show insignificant changes which should not harm the foot in the long-term. We believe the fourth-toe transplantation is a promising method to use to reconstruct congenital or traumatic absence of digits for pediatric population.

Original languageEnglish
Pages (from-to)74-80
Number of pages7
JournalTechniques in Hand and Upper Extremity Surgery
Volume23
Issue number2
DOIs
Publication statusPublished - 1 Jun 2019

Keywords

  • congenital hand deformity
  • fourth toe
  • toe-to-hand transplantation

Field of Science

  • 3.2 Clinical medicine
  • 3.3 Health sciences

Publication Type

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database

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