Split second- and third-toe transplantation in mutilating-hand-injury reconstruction.

Although bilateral second-toe transplantation has offered a satisfactory solution for multiple toe transplantation when the neighboring amputation stumps present an intact web space, exceptions exist. To provide an alternative and adapt the experience from the established methods, we propose split second- and third-toe transplantation in a 1-stage hand-function reconstruction. Three male patients underwent 4 split second- and third-toe transplantations for fingers amputated distal to the preserved or recreated web space. The average age was 22 years old, and all patients were reconstructed secondarily. No failure of transplantation occurred. All patients achieved restored hand functions for daily and occupational activities. In situations in which multiple lesser toe transplantations are required and harvesting toes from the bilateral foot may be needed, a split second- and third-toe transplantation with a healthy contralateral foot for allowing another toe transfer proves to have a satisfactory functional result and affords an opportunity for simultaneous or staged great toe transplantation.