Functional Complications

The main reason to perform a toe to hand transfer is to improve and function. It is disappointing when results do not approach expectations. Secondary procedures to improve functionality are required in up to 20% of cases of transfers.2 The most common functional complication is tendon adhesion, which must be differentiated from stiffness. In Wei and Yim' s study12 of 133 toe to hand transfers, tenolysis was the most common secondary surgery (7%), followed by arthrodesis and web space deepening. Flexor tenolysis is especially useful. Stiffness is best treated with aggres

sive hand therapy. Function may also be improved with various tendon transfers as deemed necessary, most frequently opponensplasty.1

Malalignment requiring rotational osteotomy is less frequently required as the surgeon becomes more experienced in toe transfer technique. Poor sensory return must be taken in context with the age of the patient, but may require nerve grafting. These patients are more susceptible to burns until protective sensation develops.

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