Reconstruction of four damaged or destroyed ipsilateral fingers with free toe-to-hand transplantations.

Three patients with traumatic partial or complete loss of all ipsilateral digits, excluding the thumb, were reconstructed with free microvascular toe transplantations for all involved digits. In two cases, two pairs of combined second and third toe transplantations were utilized; in the third case, four separate toes were employed. Clinical follow-up was 8 1/2 years, 2 years, and 1 2/3 years. Detailed functional analysis was performed. All patients except the first had initially undergone reconstruction of only two digits and had requested a second procedure to transfer two additional toes. While reconstruction of the thumb and two opposing digits is adequate in most cases, selected patients may benefit from the additional two digits, especially with respect to improving hook grip.