TOE-TO-HAND TRANSFER

Toe-to-hand finger transfer is a preferred treatment for traumatic losses or congenital anomalies. Traumatic losses are the cases where the thumb is totally or near totally, or there is a loss of multiple fingers, although there is a healthy thumb.

Toe transplantation is used more rarely for congenital anomalies. However, it can be used in some cases where the thumb is not developed (thumb hypoplasia), symbrachydactyly where the fingers are both attached and very short or constriction band syndrome.

In traumatic thumb loss, transfer of the index finger of the same hand for thumb replacement may be an alternative for suitable cases.

Ideally, at least three points are required for the hand to perform the holding function. This is possible with at least three fingers. In order to provide the basic functions of the hand, one finger should be able to support by at least two fingers while functioning like a thumb. The lack of the thumb can be corrected by transferring the big toe or the second toe, taking into account the advantages and disadvantages. In cases where the thumb is present and the other fingers are absent, the second and third toes are transplanted together. 

Which of the big toe or second toe will be transferred; It is decided whether the transplant will be done with the metatarsal bone, the size of the toes and fingers, and the patient's preference in this regard. The transfer of the big toe provides a very strong stability and a very mobile toe at the distal joint (interphalangeal joint). However, some situations can create disadvantages. It may not be preferred if there is an huge size difference between the first toe and thumb. If the defect is longitudinally bigger and it is necessary to transplant the metatarsal , too, then the first toe is not preferred. The metatarsal head of the big toe is important for us to step on our feet. When it is removed, the dynamics of walking may be impaired. In addition, the removal of the big toe leaves a more obvious cosmetic deformity than the removal of the second toe. The second toe can correct longer deficiencies. Its deficiency does not create a very obvious aesthetic loss. Also, regardless of the length taken, it does not affect the walking function. However, it is not as good as the big toe in terms of strength and mobility.

Surgery can be thought of as basically replanting a severed finger. The arteries and veins of the finger to be transplanted are brought together with nerves (for feeling), tendons (for movement), and the bone on the recipient area. Most of these require the use of microsurgical techniques. However, in some cases, soft tissue deficiencies in the recipient area may require other preparatory operations (flap application) before transplantation. Incompatibility between the transplanted finger-recipient vessels may cause problems in some patients, from revision surgeries to the loss of the transplant.

Finger deficiencies can cause many problems such as being able to continue one's profession, meeting daily personal needs, and the cosmetic deficiencies. Toe transfer to hand promises very satisfactory results in suitable individuals with both functional and psychosocial benefits.