Combined third and fourth toe transplantation.

Multiple toe transplantation has been established as an effective technique for restoring prehensile ability in the metacarpal hand. The combined third and fourth toe transplant is a new toe transplant that has been developed for bilateral metacarpal hand reconstruction. Since 1991, the combined third and fourth toe transplant was added to the armamentarium of toe transplants for metacarpal hands, although its role in metacarpal hand reconstruction has not been described previously. This article introduces the indications for combined third and fourth toe transplant, outlines relevant vascular anatomy, and discusses technical considerations pertaining to toe harvest and transplantation.