Cosmetic Reconstruction of Distal Finger with Second Toe-to-Hand Transfer

ABSTRACT

A series of 17 distal finger reconstructions was successfully performed with second toe-to-finger transfer for the aesthetic purpose. The static 2-point discrimination averaged 9 mm. Total active range of motion was 205 degrees. The mean extension deficit of transferred toe was 10 degrees. Key-pinch and grip power averaged 65% and 90% of the normal opposite site respectively. The subjective satisfaction scores of aesthetic appearance and function on the new reconstructed distal finger by patients' self-assessment were 82 and 78 in average, respectively, over a total score of 100. And, those of foot averaged 88 in function and 77 in aesthetic appearance. For aesthetic refinement in distal finger reconstruction with second toe-to-hand transfer, skeletonization of the neurovascular bundle of the harvested toe as well as intraoperative expansion of the subcutaneous tunneling between skin incisions can avoid unsightly scars on the reconstructed fingers. Defatting of the skin flaps of the amputated fingertip and zigzag incision on the toe flap lead to smooth junction between the amputated digit and the transferred toe. Arterial microanastomosis was done at the interdigital web space to avoid small caliber of the pedicle and cold intolerance. Cosmetic reconstruction of the distal finger with second toe-to-hand transfer leads to high satisfaction of the patients both aesthetically and functionally. This is another new field of cosmetic surgery for the distal finger defects.