[Free transplantation of the 2d toe. Technical features, problems and solutions].

On the basis of seven transfers of the second toe and one "en bloc" transfer of the second and third toe, technical features are discussed. The use of a plate for osteosynthesis is proposed. It has been found very useful, particularly when a MP-arthrodesis is performed between the first metacarpal and the second toe. It gives stability and therefore secondary displacement and/or rotation of the toe are avoided. It enables more accurate tension to be placed on the repaired tendons. For the flexor tendons it is suggested to repair the communis longus only, whereas both extensors, longus and brevis, and eventually the distal tendon of the lumbrical muscle should be sutured to avoid a PIP flexion contracture. In one case the revascularisation of the transfer was effected through the dorsalis pedis artery. In the seven other cases the digitalis plantaris communis I artery was used either as a substitute or as a complementary vessel. Under good conditions the repair of only one vein can be sufficient. Collateral plantar nerves as well as dorsal nerves must all be repaired. The use of fibrin glue for their suture is mentioned. A cutaneous defect is frequent on the lateral sides of the transferred toe. It can be first covered with Epigard and secondarily grafted after one or two weeks. That method was used in five out of eight cases.