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Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Report on 250 consecutive toe to finger transplants. Indications, results, failu...
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Vol. 55. Issue 4.
Pages 257-262 (July - August 2011)
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Vol. 55. Issue 4.
Pages 257-262 (July - August 2011)
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Report on 250 consecutive toe to finger transplants. Indications, results, failures, and new applications
Informe sobre el trasplante de 250 dedos del pie a la mano consecutivos. Indicaciones, resultados, fracasos y nuevas aplicaciones
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Francisco del Piñal
Corresponding author
drpinal@ono.com

Corresponding author.
, Francisco Javier García-Bernal, Carlos Thams, Alexis Studer, Javier Regalado
Instituto de Cirugía Plástica y de la Mano Dr. Piñal y Asociados, Hospital Mutua Montañesa y Práctica Privada, Santander, Spain
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Abstract
Purpose

Toe-to-hand transfers are an essential part of hand rehabilitation after loss of a finger. Despite this, the likelihood of failure and the hypothetical morbidity in the donor area, made this procedure not very popular among surgeons. The purpose of this paper is to present our clinical experience, highlighting the pitfalls and the new indications.

Material and methods

Between February 1995-January 2010 we performed 250 toe-tohand transfers for finger amputations. In metacarpal hands (23 cases) we transferred the hallux from one foot and the 2nd and 3rd from the other, to achieve a three-fingered (tripod) grasp. The rest of the patients had multi-digit, simple or partial amputations. In 69 the thumb was reconstructed and the rest of transfers were for finger reconstructions.

Results

Re-operation rate due to acute ischaemia was 16% (10% intraoperative) and the overall success rate was 98.8% (3 failures). There was no partial necrosis in any case. Regarding the donor side, one patient was operated on due to a painful neuroma; the rest did not have complaints in the donor area.

Conclusions

In our experience toe-to hand transfers are a safe and reliable method to rehabilitate severe hand injuries. Donor site morbidity is directly related to the number of toes harvested, and is well-tolerated by the patients, especially in severe injuries.

Keywords:
Amputation
Microsurgery
Toe-to-han
Resumen
Propósito

Las transferencias de dedos del pie constituyen un arma fundamental en la rehabilitación de las lesiones de mano. Sin embargo, no gozan de mucha popularidad dada la posibilidad de fracaso y por las hipotéticas secuelas en la zona donante. Presentamos nuestra experiencia clínica, haciendo especial hincapié en las complicaciones y las nuevas aplicaciones.

Material y métodos

En el periodo febrero de 1995 - enero de 2010 hemos realizado 250 transferencias de dedos del pie para amputaciones de todos o parte de los dedos. En las amputaciones de todos los dedos (23 casos) se trasplantaron el hallux de un pie y el 2.° y 3.er dedos del pie contralateral para lograr una pinza trípode. El resto de los casos corresponden a amputaciones multidigitales, simples o parciales de dedos, siendo 69 casos pulgares y el resto, dedos trifalángicos.

Resultados

La tasa de reintervención por isquemia aguda fue del 16% (10% intraoperatoria), con una supervivencia final del 98,8% (3 fracasos) tras la revisión quirúrgica. No hubo ninguna necrosis parcial. Respecto a la zona donante, un paciente fue intervenido por presentar un neuroma; el resto no refirió ningún tipo de molestias a la marcha, en el seguimiento a largo plazo.

Conclusiones

En nuestra experiencia, las transferencias de dedos del pie son un método seguro en la reconstrucción de lesiones graves de la mano. La secuela del pie es proporcional a la cantidad de dedos que se tomen, y es bien aceptada por el paciente, en especial en las graves lesiones.

Palabras clave:
Amputación
Microcirugía
Dedo del pie a la mano
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Copyright © 2011. Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT). All rights reserved
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