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    Toe To Hand Transfer

    What is a toe to hand transfer?

    The toe to hand transfer operation can be used to create a new digit/ thumb on the hand for conditions such as loss of a digit due to illness, injury, or children with absent digit due to symbrachydactyly or amniotic band syndrome/ constriction ring syndrome.

    The transferred toe can either act as a thumb or allow the thumb to have pinch grip. It has a nail, and joints which can bend and straighten, although not as much as finger joints.

    Which is an ideal toe for toe transfer?

    The toe next to the big toe is usually the most suitable and contains the joints, tendons, tissues and nail to make a good finger. The toe is removed from the foot, taking with it all the associated blood vessels, nerves, bones and tendons, and then is transplanted to the hand. It is important to remember that, even after the transfer, the new finger will only have the range of movement of a toe.

    For toe transfer, feet should be normal, otherwise operation may be difficult to achieve good result or not be possible. Occasionally the big toe is used but this usually affects the general appearance of the foot.

    Will it affect foot function?

    Removing one toe leaves a foot reduced in width, with four toes present. The gap where the toe was removed is closed. Removal of the second toe does not have any functional impact on walking, running or jumping.

    Will toe to hand transfer improve the look and function of hand?

    It will improve the appearance of hand as well as hand function by improving grasp and grip. But it will not achieve a normal looking hand.

    What are the operative steps?

    Toe to hand transfer is carried out under general anaesthetic. Firstly surgeon examines affected hand to assess that there are appropriate blood vessels, nerves and tendons within the hand and arm, to which the toe can be attached. If there are no appropriate blood vessels, nerves and tendons, then surgery is abandoned. 

    Once the appropriate structures are identified in the hand, then toe is removed with its own blood vessels, nerves and tendons. The gap between the big toe and the third toe is then closed with stitches and a dressing is applied. The toe bones are joined to the hand bones and fixed together with a wire (K-wire) and left to heal for approximately six to eight weeks, then tendon, nerves and blood vessels are joined. At the end of the procedure, the surgeon will put dressing on your hand to protect it while it heals. There will also be a dressing on the foot. The whole surgical procedure will take several hours.

    What are the risks/ complications of toe transfer surgery?

    There are few risks like Bleeding, infection, anastomotic thrombosis, donor area suture line dehiscence, lastly 5% failure rate.

    What is postoperative protocol?

    • Patient will be monitored closely, by regularly checking the blood supply to the new digit for first few days.
    • Patient need to be kept warm and well hydrated so that the blood flows is adequate.
    • Patient is given blood thinning medicine to stop any clots forming and blocking the blood vessels.
    •  Patient also gets analgesic and antibiotic during post operative period.

    What are the post operative important instructions?

    • Plenty of liquids intake
    • Avoid cold exposure
    • Foot and hand keep elevated
    • You are not allow to keep your foot down for next 2 week

    How do you follow up patient and what long term care is required?

    • For a dressing change and removal of the K-wire about six weeks after the operation.
    • Sensation return takes between three and six months, it is important to protect your hand from heat and cold and sharp objects.

    What is the outcome of toe to hand transfer surgery?

    The transferred toe can either act as a thumb or allow the thumb to have pinch grip. It has a nail, and joints which can bend and straighten, although not as much as finger joints.

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