Microsurgical Reconstructions
The introduction of the microscope has help magnify the surgical field and allowed surgeon to do greater things. With the introduction of microsurgery, micro-reconstructive surgeons can now transfer tissues from one part of the body to another to replace loss.
One of the more common microsurgical reconstructions seen in hand surgery is the transfer of toes to the hand to replace loss of the digits. This is particularly useful when using the toe to replace a loss thumb. This is because the thumb is equivalent to about 50% of the hand function.
Below is a young man who lost his thumb in a meat grinder and had opted for a big toe to thumb transfer. The important thing in a toe to thumb transfer is to make sure that the transferred toe looks exactly like the thumb otherwise the patient may find it difficult to use.
Figure A shows a hand with loss of the thumb at proximal phalangeal level. The left image shows the right big toe is being harvested.
Figure B: Results of toe to thumb transfer
A child with gangrene of the right thumb following an electrical burns. She had an amputation and due to her age, a second toe was used as a donor.
A young man with an infected forarm wound had resulted in skin loss., bone loss and nerve loss. A fibular graft taken from the left leg was used as a donot to replace the loss nerve, bone and skin.
Post-operative fixation of the arm with a double barrel fibular graft and fixes with plate and screws.
