Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 1:
Great Toe Transplantation
  FIG.1-17. Appearance of the donor foot. A large portion of the dorsal medial aspect of the first metatarsal head has been removed to permit closure of the donor wound on the foot. Delay in healing over the metatarsal head is not unusual. Care should be taken to prevent pressure in this area with the postoperative dressings.


This case also involves a four-fingered hand. The photographs are of the first patient in the United States to have a successful toe transplant using microvascular techniques (1972). (From Buncke, H.J., et al.: Thumb replacement; great toe transplantation by microvascular anastomosis. Br. J. Plast. Surg. 26(3):195, 1973.)

FIG. 1-18. Loss of the thumb through the distal portion of the first metacarpal.

FIG. 1-19. X ray shows the residual metacarpal bone. Every effort should be made to preserve length after thumb amputations so that reconstruction can restore a near normal condition. If the articular surface is present, it should be preserved so that a compound joint can be made between the metacarpal articular surface and the proximal phalanx of the toe.

FIG. 1-20. The patient is shown drawing the illustrations used in the article documenting this case.


FIG. 1-21. The patient has restoration of strong grip, pinch, and grasp; he is a licensed contractor.

FIG. 1-22. Postoperative x ray shows the solid bony junction between the proximal phalanx of the toe and the metacarpal, using an intramedullary peg from the pretibial area to preserve length.


A woman lost her thumb through the proximal phalanx in a water skiing accident. Length was preserved by covering the amputation stump with a tube pedicle graft from the abdomen.

FIG. 1-23. The toe on the foot is considerably larger than the right thumb.

FIG. 1-24. The toe has been transplanted to the thumb position and with time has atrophied, shrunk, or adapted considerably. The patient has good opposition to all fingertips and restoration of grasp and pinch.

FIG. 1-25. The transplanted toe has decreased in size and become even more thumb like after about 2 years. (From Valauri, F.A., and Buncke, H.J.: Thumb reconstruction-Great toe transfer. Clin. Plast. Surg. 16:475, 1989.

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