Reconstruction of severe transmetacarpal mutilating hand injuries by combined second and third toe transfer.

This paper reports on nine instances of combined second and third toe-to-hand transfers in eight patients for severe transmetacarpal mutilating hand injuries. In four cases, the transfer included an innervated flap from the fibular side of the great toe to provide sensibility to a previously constructed osteoplastic thumb. Prehensile function was significantly improved by providing chuck or tripod pinch as well as improved pulp-to-pulp and lateral pinch. At a mean follow-up of 20.3 months, there was only one failure.