|| FIG. 1-84. The great toe, although bigger in circumference than the thumb, is identical in all anatomic features. The hands at lower right are those of the author, who is left-handed.
FIG. 1-85. Once transplanted to the hand, the toe reduces in size.
FIG. 1-86. The ability to flex the interphalangeal joint is one of the most valuable functions of the great-toe transplant. Extension is shown. (From Valauri F.A. and Buncke H.J.: Thumb reconstruction-Great toe transfer, Clin. Plast. Surg. 16:475, 1989.)
FIG. 1-87. Flexion is shown.
FIG. 1-88. Thirty to 40 degrees of forceful flexion permit the thumb to act as a "vise grip".
FIG. 1-89. Interphalangeal flexion is required to grasp many objects.
FIG. 1-90. Pulp-to-pulp opposable sensate pinch restores proprioceptive feed-back to the brain, important in a multitude of tasks.
FIG. 1-91. Shoe tying.
FIG. 1-92. Preservation of the nail pulp complex increases tactile sensation and fingertip function.
FIG. 1-93. Key pinch between the thumb and index distal, middle, or proximal phalanges permits the patient to grasp small objects.
FIG. 1-94. Key pinch also permits the patient to manipulate objects from hand to hand.
FIG. 1-95. Chuck or three-finger pinch is more sophisticated and permits the patient to manipulate fine instruments and eating utensils.
FIG. 1-96. Restoration of controlled grip or grasp permits the thumb, palm, and fingers to work in unison, e.g., in grasping tools.
FIG. 1-97. Shuffling cards.
FIG. 1-98. Manipulating a Rubik cube.
FIG. 1-99. The donor defect on the toot is an acceptable trade-off for increased hand function.
FIG. 1-100. "Great toes make great thumbs."