Toe-to-hand transfer. Current concepts, techniques, and research.

The current status of toe-to-hand transfer at the Chang Gung Memorial Hospital is presented. Various combinations of toe-to-hand transfers have been used routinely for reconstruction of lost digits as well as parts of the digits distal to the sublimis insertion. Early, one-stage reconstruction is recommended in patients with clean wounds when replantation is not feasible. The decision of which technique to be used in certain patients is highly individualized. Technical refinements have been introduced aimed at simplifying the technique of toe harvesting and improving the function and appearance of the reconstructed digits as well as donor sites. Aggressive motor rehabilitation and sensory re-education are essential for optimal functional recovery. Current research projects involve evaluation of patients using the computerized work simulator, gait analysis, and somatosensory evoked potentials. Morphometric studies of the digital nerves in the fingers and toes have been performed to determine the effect of neurotization upon the degree of sensory recovery.