Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 1:
Great Toe Transplantation
  FIG. 1-44. The normal Tight thumb is on the right side of the normal right toe. The transplanted left toe has reduced in size after being on the hand for over a year. Further tissue can be removed from the transplanted toe for esthetic reasons by taking wedges from the medial and lateral surfaces of the thumb distal phalanx. In over 70 great-toe transplants, only one patient has requested revisionary procedures because of the disproportionate size of the transplanted toe.


Great-toe transplantation was performed as part of staged reconstruction following a severe burn. (From Buncke, H.J.: Aesthetic aspects of hand surgery. Clin. Plast. Surg. 8:349, 1981.)

FIG. 1-45. The initial injury has severe contracture and frozen MP joints.

FIG. 1-46. Volar view of injury in FIG. 1-45.

FIG. 1-47. Contracted, atrophic skin was initially replaced with a free groin flap, providing coverage for the base of the anticipated great toe transfer.

FIG. 1-48. The toe has been disarticulated at the MCP joint and transplanted with a long flexor tendon to allow tendon repair well above the wrist.


FIG. 1-49. The transplanted thumb allows firm pinch. The first web space was later widened with a second groin flap.


A 36-year-old patient suffered a crushing injury of the hand.

FIG. 1-50. The thumb was amputated through the base of the metacarpal, along with index and long fingers.

FIG. 1-51. The arteriogram shows intact flow to the base of the thumb stump.

FIG. 1-52. Preoperative planning was done using a toe model, including plans to use the resected first metatarsal as a bone peg into the remnant metacarpal.

FIG. 1-53. Postoperative view shows broad first web space.

FIG. 1-54. There is good opposition to the ulnar fingers.


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