Abstract
Background Microsurgical toe-to-hand transplantation is a reasonable salvage procedure after
failed replantation, though no consensus exists on proper donor toe length for restoration
of hand function and optimal donor flap needed for recipient site healing. The purpose
of this study was to introduce a novel technique for preoperative planning in complicated
toe-to-hand reconstruction and to assess feasibility in four cases.
Methods Computed tomography (CT) angiography was used to map donor site vasculature, whereas
CT data were used to create three-dimensional (3D) soft tissue and skeletal models
for injured and uninjured hands. Based on the reformatted model (mirror of uninjured
hand), soft tissue and finger skeleton models were generated using a 3D printer. An
adhesive plaster model was placed on the donor site to determine osteotomy level and
incision markings. The skeletal model was used to determine the length of the donor
foot resection. Four complex amputation cases were included to illustrate clinical
feasibility and early functional and cosmetic outcomes.
Results In all four cases, thumb and fingers were reconstructed successfully and all flaps
survived. No arterial or venous thrombosis or major donor morbidity were observed.
Functional and cosmetic outcomes were satisfactory with similarly satisfactory static
two-point discrimination, key pinch and grip strength, and Michigan Hand Outcomes
Questionnaire scores.
Conclusion This novel microsurgical toe-to-hand reconstruction methodology, as introduced in
this study, showed promising functional and cosmetic outcomes. Application of this
technique in complex hand injuries has the potential to increase surgical efficiency,
minimize procedural morbidity, and improve reproducibility.
Keywords
microsurgery - toe-to-hand - transfer - computed tomography angiography - CT surgical
planning
