Modification of hand reconstruction with unilateral foot donation

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Multiple toes transplantation is an effective method for restoring the prehension of the hands.1-5 Generally, the thumb, index and middle finger are reconstructed by transferring a free big toe skin-nail flap with the second and third toes from a same foot. The great saphenous vein, superficial veins on the dorsum of the foot, the dorsalis pedis artery, and the first dorsal metatarsal artery are resected to be used as the donor pedicle. The arterial pedicle is freed up to the dorsal digital artery of the big and second toes. Both the second and third toes are supplied by the dorsal digital artery of the second toe on the tibial side. By using unilateral toe donation to reconstruct a digitless hand, we can preserve the normal form and function of the contralateral foot.However, because of the small length of the digital arteries between the big and second toes, the first web space is limited. Here we present our experiences on two cases of hand reconstruction with unilateral three toes transplantation. Good function and motion range of the thumb were achieved in both the patients.
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