Toe-to-Thumb Transfer

The toe-to-thumb transfer provides the best functional outcome in patients sustaining traumatic amputations of the thumb who desire reconstruction. While it can be used successfully in patients with congenital hypoplastic thumbs, index finger pollicization is often the procedure of choice. Adequate length of the proximal phalanx with preservation of an intact and supple MCP and CMC joint is a prerequisite for a toe-to-thumb transfer. This procedure is technically challenging and should not be attempted by inexperienced surgeons in extremity reconstruction. A successful outcome for this procedure requires detailed knowledge of the structural anatomy. The first webspace needs to be of normal width. Any first webspace contracture needs to be treated well in advance. The first webspace may be addressed with scar excisions, z-plasty, or pedicled flap at least 3 months prior to a toe-to-thumb transfer.