Onycho-Osteocutaneous Defects of the Thumb Reconstructed by Partial Toe-to-Thumb Procedure in Manual Workers

The authors presented their experience in very distal thumb amputations reconstructed by partial toe-to-hand procedures in manual workers (excluding soft tissue losses).

Nine patients who suffered amputation of the thumb distal to the IP joint were included in the study. Except for one referred late, all were reconstructed in less than 1 week after the accident (most in less than 48 hr). The bony defect varied from just the tuft of the phalanx to the need for reconstruction of the IP joint (2 cases). The toes were based on the proper digital artery (3 cases), the intermetatarsal artery (5 cases), and the dorsalis pedis (one case).

All toes survived without complications. At a mean follow-up of 3.2 years, active range of motion at the IP joint was superior to 55° in every case. Two-point discrimnation was normal in the dorsal oblique amputations and 7 to 11 mm in the rest. One case had a moderate nail deformity while, in the rest, a fairly normal (subjectively 9.5 on a VAS) growth was appreciated. Patient satisfaction was high from a functional and aesthetic standpoint, 9.75 and 9.5 (over 10). All patients returned to work from 2 to 4 months after the injury.

In contrast to classic teaching that recommends stump closure for cases of distal thumb amputations (Campbell 2003), the authors have achieved excellent results with partial toe transfer in manual workers. In their experience, the thumb can be restored nearly “ad integrum” with acceptable donor-site sequelae. The best indication is for cases of dorsal oblique amputation, as thumb sensibility is preserved. Early transfer is strongly recommended.