| Abstract [eng] |
Introduction: Amputation of the thumb carries significant consequences for patients, as it leads to marked loss of both hand function and aesthetic appearance. Injuries located proximal to the middle third of the thumb typically require complex surgical reconstruction techniques (1). When replantation is not feasible and pollicization is not appropriate free toe-to-thumb transfer remains the preferred reconstruction option (1,2). Aim/Objective: This systematic review evaluated recent literature on microsurgical thumb reconstruction with toe grafts, focusing on functional, sensory, aesthetic, and complication outcomes, as well as donor-site morbidity. To reflect current surgical practice, only studies published within the past ten years were included. Summary: In total, 13 studies comprising 256 reconstructed thumbs were analyzed, along with three additional studies addressing donor-site outcomes (n=77). Overall, flap survival was 99.6%, with only one reported case of flap loss, underscoring the reliability of the procedure. Functional results showed restoration of meaningful opposition, with Kapandji scores ranging from 4 to 8, and grip strength reaching approximately 50 to 86% of the contralateral side. Sensory recovery was consistently achieved at a protective level, although fine tactile discrimination remained limited (mean two-point discrimination: 7.06 mm). Patient-reported outcomes indicated high level of satisfaction with both functional and aesthetic results. However, outcomes reporting varied considerably between studies, making direct comparison difficult. Despite this heterogeneity, overall complication rates were low. Donor-site analysis demonstrated measurable biomechanical changes, particularly in plantar pressure distribution, even though patients reported good overall satisfaction. The different surgical techniques used in toe-to-thumb transfer reflect a balance between functional performance, aesthetics, and donor-site morbidity. Great toe-transfer generally provides good strength and stability, whereas second toe-transfer is associated with less impairment at the donor site and may be preferable in patients concerned about gait or appearance. Modified techniques, such as the trimmed great-toe, and the wrap-around technique, have been developed to improve aesthetic outcomes and allow for more individualized reconstruction. These approaches, however, may involve trade-offs, including decreased mobility or functional performance. Conclusion: In summary microsurgical thumb reconstruction using toe transfer remains a reliable and safe method, that achieves favorable functional and aesthetic results. Nonetheless, donor-site morbidity and inconsistent outcome reporting underscore the need for standardized assessment and further long-term studies. |
