Reconstruction of Thumb and Finger by Transplantation of Composite Toe Tissues: Experience in 208 Cases / 中华创伤杂志

ABSTRACT

Transplantation of composite toe tissues with microsurgical technic has boen performed in 208 patients since Oct. 1979. Among the 242 digits reconstructed, 238 digits (204 patients) were successfully reconstructed and other four digits (4 patitents) failed. The success rate was 98.3%. In this series, 135 cases were loss of thumb, 28 cases loss of fingers, and 45 cases loss of both thumb and fingers. The reconstruction procedures were composed of thumb reconstruction in 166 cases (168 thumbs), finger reconstruction in 28 cases (42 fingers) and both thumb and finger reconstruction in 14 cases (32 digits). The transplantation of second toe were performed in 188 cases and nail-skin flap of great toe transplantation were used in 18 cases. Gilbert Ⅲ variation of the first dorsal metatarsal artery was encountered in 34 donor feet in 30 patients. All these cases were successfully operated upon. A new classification system of thumb loss is proposed. The indication of various operative procedures, different ways of vascular anastomosis, the choice of emergency reconstruction, the use of graft of toe extended with dorsalis pedis flap and the pitfalls of the operation were discussed in detail.