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 This
patient has lost his thumb in an
industrial accident. The thumb is the
most important finger on the hand, and
is felt by some to be worth 80% of the
function of the hand. By transplanting
the great toe to the thumb position, the
patient is able to regain lost function.
In
preparation to harvest the great toe, a
pencil Doppler is used to map out the
main arterial blood supply to the toe.
The arterial flow to the toe can be a
dorsal or plantar dominant system.
 The
toe has been harvested and a dissection
of the blood vessels, nerves and tendons
to the toe is revealed. A single artery,
vein, two nerves and two tendons are
repaired after the bone fixation is
performed.
 The
toe has been positioned on the hand and
the bone, tendons, nerves and vessels
have been repaired. The implantable
Doppler probe is seen coming from the
wound and fixed to the arm. The probe
allows for post-operative monitoring of
the transplant by providing an audible
assessment of blood flow through the
draining vein.
 The
transplanted toe acts as the new thumb.
It is larger in size than the normal
opposite thumb, but with time some
atrophy does occur. The patient can
choose to have some of the bulk removed,
but most are happy with their new thumb.
 The
great toe provides two main advantages
over transplanting the second toe. It
looks much more like the native thumb
and it provides more power grip than the
second toe does.
 The
foot donor site is well healed. The
patient is able to walk normally.
Although the great toe is lost, the
patient has gained a thumb. This
case the scar is a little thick on the
dorsum of the foot. But with time, this
should flatten out. Occasionally,
patients will require some secondary
revision surgery on the foot.
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