Evaluation of sensibility and function with microsurgical free tissue transfer of the great toe to the hand for thumb reconstruction.

Detailed evaluation of sensibility and function on 10 patients was carried out on an average of 42 months after thumb reconstruction by microsurgical free tissue transfer. Sensibility based on modified two-point discrimination and ridge criteria was found to be directly related to the patient's age at time of neurosuture. The plantar aspect of the distal 2 cm of the normal toe showed two-point value averaging 6 mm in 20 normal shoe-wearing adults, compared to values of 12 mm when the toe was tested over the plantar surface of the proximal half of the distal phalanx. Metacarpophalangeal joint motion and interphalangeal joint motion were limited when compared with the opposite normal thumb and unoperated great toe. Grip strength and pinch strength reflected the degree of associated injuries in the hand. Cold intolerance was present in all patients. Patients' subjective assessment of their ability to use their hand as compared to their hand prior to injury was rated at less than 10% preoperatively compared to 52% to 87% postoperatively. None of the patients perceived a problem of social acceptance after the surgery. Postoperative studies of the feet revealed concentration of weight bearing between the second and third metatarsal heads on Harris mat studies and slowing of the forward and medial progression of the center of pressure on gait analysis. Some weakness in push-off and cutting maneuvers in sports activities was reported in half of the patients. None of the patients experienced difficulty when running long distances on level ground. All the patients returned to gainful employment postoperatively.