Problems in toe-to-hand transfers.

The problems encountered by the author in 70 cases of toe-to-hand transfers are considered under three main headings: (1) operative problems (2) post-operative problems and (3) functional problems. The operative problem of preserving the integrity of the donor vessels is related to the varying patterns of vasculature of the foot. Bony fixation of the donor toe to the recipient site and the selection of veins of the right size and length are the other main operative problems. The post-operative problems are concerned with the problem of survival of the transplanted toe and these include venous congestion, diminished arterial blood flow due to thrombosis or spasm, bleeding and delayed healing, especially at the donor site. In thumb reconstructions, both motor and sensory functional recovery were good when reconstruction was done at the M-P joint level, but less satisfactory if done at a more proximal level. Similarly, the functional problem in finger reconstructions resembled those of thumb reconstruction. At the donor site, the main foot functions were maintained, though delayed healing and scarring may prove troublesome in a few cases.