gms | German Medical Science

Objectives/Interrogation: Although the 2nd toe-to-hand transfer has been the main choice of finger reconstruction since 1965, the reconstructed finger still results in a toe appearance when the 2nd toe was transferred to finger without any re-shape. Various technical refinements have been used to optimize the appearance of reconstructed fingers, but few attempts have been made to define the specific indications for these techniques or for considering which procedures are applicable in certain circumstance. This study was to provide useful guideline for selection of the proper one-stage re-shape procedures of 2nd toe and make the reconstructed fingers present a relatively-normal appearance and perform their functions.

Methods: The 2nd toe was classified, and then one-stage re-shape procedures were proposed for each classification. In total, Fifty-seven fingers with different levels of defects in 41 cases were reconstructed with 2nd toe transfer since 2007. Various surgical procedures were performed to re-shape 2nd toe according its type and the measured data.

Results and Conclusions: Twenty cases were lost to follow-up, and only 21 cases including 33 fingers attained 6 months to 9 years (averaged 4.2 years) follow-up, with 51.2% follow-up rate. We referred to the assessment criteria after toe-to-hand transfer issued by International Federation of Societies for Surgery of the Hand and Hand Surgery Association of China Medical Association, ATM:100°-215°, ADL:15-20 points, Static two-point discrimination: 4-10mm. Eight cases were "very satisfied" with the shape of fingers, and 13 cases were classified as "satisfied". Twenty fingers out of 13 cases were excellently recovered, and 13 fingers out of 8 cases were acceptable recovered. Totally, 100% of fineness was reached. Conclusions: Therefore, it suggests that the classification and one-stage re-shape procedures of 2nd toe varying with each type are effective to reconstruct aesthetic fingers.