Background
The aesthetic and functional considerations of the human thumb cannot be underestimated. It provides at least 50% of the hand function, but the thumb also serves as an important aesthetic component of the hand during common social interaction. Therefore, a traumatic amputation is catastrophic, and authors have described alternatives for thumb reconstruction. However, Cobbett (1969) was first to demonstrate a great toe to thumb transfer. This has become the gold standard for traumatic thumb reconstruction. This procedure has evolved alongside other methods including second toe transfer, and great toe wrap around. Although a great like for like match, few have demonstrated the durability and longevity of this reconstruction. We present the functional outcome of a toe-to-thumb transfer more than 20 years post-operatively.
Methods
A 45-year-old right hand dominant butcher received a delayed right toe to thumb transfer on March 1999; following a traumatic crush/avulsion amputation through the proximal phalanx 18 months prior. Routine microsurgical technique involved an end to side dorsalis pedis to radial artery anastomosis, and superficial toe veins to cephalic vein; including primary digital nerve neurorrhaphy.
Results
Routine postoperative follow-up of 23 months demonstrated a functional reconstruction with a pinch strength of 9 kilograms vs 8.8 kilograms on the left. Follow-up more than 20 years post reconstruction demonstrated persistent function with 7-kilogram pinch grip in the right thumb compared with 6 kilograms contralaterally. Kapandji score of 9/10. Subjectively his sensation was scored at 9/10. The reconstruction permitted return to employment as well as activities of daily living.
Conclusion
We present the functional outcomes from a 20 year post traumatic old toe to thumb reconstruction. This case not only reinforces the functional capabilities of such a reconstruction, but also highlights the longevity and durability in demanding occupations.