Toe to Hand Transfer

The hand is an important part of the body that helps in a multitude of actions. Each finger is an integral part of the hand and has its own function and role to play in assisting the hand in its many actions. Hence, the loss of a finger can become a challenge in performing everyday activities. This impairment can be treated through a toe to hand transfer procedure. The toe to hand transfer surgery is a complex microsurgical procedure performed to remove a toe from the foot for the creation of a new digit on the injured hand. The surgery can be performed because the hand and foot have many similar anatomical features. This surgery is mainly conducted in children who do not have a thumb.

Indications and contraindications

The toe to hand transfer operation is performed in individuals who have lost their finger due to traumatic injury or congenital illnesses such as ring constriction syndrome (malformation due to constriction of fetal tissue by fibrous bands of the amniotic sac) and symbrachydactyly (stiff, webbed, short, or missing fingers).

However, the toe to hand transfer may not be recommended for conditions that may interfere with the procedure like severe mental diseases, atherosclerosis, trauma to the foot and vascular diseases.

Pre-surgical considerations

Before starting the procedure, your child’s doctor will take photographs of the hands and feet to compare and measure the changes following the surgery. The surgeon will closely examine your child’s diseased hand and arm to ensure that it is supplied by nerves, blood vessels, and tendons to sufficiently support the toe. Toe transfer is not performed if these tissues are not adequately present.

Procedure

The surgery is carried out under general anesthesia. The toe next to the big toe is commonly selected for transplantation as it is considered the most suitable with appropriate tissues, tendons, joints and nail. The toe is excised from the foot with its associated nerves, blood vessels, bones and tendons. The gap left behind is closed with sutures and dressed.

The detached toe is then transplanted to the hand and fixed together with a wire (K-wire). The doctor uses an operating microscope to connect the blood vessels and nerves of the toe at the hand. A bulky dressing and plaster is placed to protect the hand and foot while healing. This may take about 6-8 weeks to heal completely.

Post-surgical care

Following the surgery, nurses will regularly check for blood supply to the new finger. Your child’s doctor may prescribe pain killers to alleviate any discomfort, antibiotics to prevent infection and blood thinning medicines to avoid clot formation, which could block the blood vessels. Your child can return home 5-7 days after the surgery.

The dressing to the foot and hand should be maintained clean and dry. Care should be taken not to perform rigorous activities until recommended by the doctor. You will be instructed to keep your child’s hand warm to encourage good blood supply to the finger. Your child may be advised to use a pushchair or wheelchair so as not to put too much weight on the operated foot. After around 6 weeks, the K-wire will be removed and the finger will be placed in a splint. Exercises may be taught to improve range-of-motion of the finger. The finger is regularly monitored for general movement and nerve sensation recovery.

Complications

Like all surgical procedures, toe to hand transfer may be associated with the following complications:

  • Bleeding
  • Poor blood flow through the repaired vessels requiring another surgery
  • Slow healing or non-healing
  • Tissue death
  • Infection
  • American Academy of Orthopaedic Surgeons
  • American Society for Surgery of the Hand
  • St. Luke's Roosevelt
  • Texas Scottish Rite Hospital for Children
  • NYU School of Medicine
  • North Shore LIJ
  • Pro Medical Newyork