Toe Transplantation

The great toe and second toe have anatomic similarities to the thumb and fingers.  In severe finger injuries, replantation or revascularization is often successful in salvaging injured digits, but when not possible, microvascular toe transplantation can be performed for  digital reconstruction.  In cases of congenital absence of the thumb or fingers, toe transplantation can often be used for reconstruction of digits.  The great toe is classically used for thumb reconstruction while the second toe is utilized for single finger or multiple finger reconstruction.  The second toe can also be used as a donor for a vascularized joint transplantation to replace arthritic or fused joints.  

Successful treatment with toe transplantation requires:

• Thorough preoperative evaluation

• Precise surgical technique with repair of bone, nerves, tendon, blood vessels and soft tissue.

• Post-operative monitoring

• Physical therapy and splinting

At its best, reconstruction of the thumb, or single or multiple digits by toe transplant, is an excellent procedure that restores function to an otherwise compromised hand. There are some Centers that feel the large toe is too great a sacrifice in terms of foot function, and second toes are preferred. In our experience with careful postoperative gait analysis, loss of the large toe is not a severe handicap; most patients live a perfectly normal existence, participating in a wide variety of sports and physical activities. With careful planning and compulsive attention to detail results of toe transplantation can be excellent.