Recovery of sensibility may take a year or more and is likely to be incomplete in older patients.8,9 Sensory recovery is maximal at two years. Two point discrimination is less than 10 mm in approximately half of patients. Nearly all patients eventually develop protective sensibility.
Kay et al tested static two point discrimination in children that had undergone second toe transfers at 9 months to 14 years of age.10 Testing was felt to be reliable in 75% of children and found to be an impressive mean of 5 mm. They found no statistical correlation between the two point discrimination and the number of digital nerves repaired. All transfers recovered protective sensibility. They hypothesize that the high quality of sensory return may be one of the many advantages performing surgery at an early age.
Range of motion following toe transfers is quite variable, but nearly all patients develop some degree of active range of motion. Transferred toes generally have greater passive motion than active motion. Kay et al found the total active range of motion was not related to the total number of flexor tendon re-pairs.10 However these results are based on children and are all second toe transfers. However, these results are based on children and are all second toe transfers. Most surgeons repair all donor tendons.
After great toe to thumb transplantation, radial and palmar abduction have been reported to be within 10° of normal with near normal flexion to the base of the small finger. Interphalangeal joint active range of motion averages 29V
The great toe transfer has been shown to provide 36% of the baseline thumb strength compared to approximately 16% for the second toe transfer. Strength is improved with the presence of thenar muscles.11 In isolated thumb loss and reconstruction, grip strength is 80-100% of the contralateral normal thumb and key pinch 65-169% of the opposite side.
Growth in Children
Expected growth in toe to thumb transplantations in children has been reported to be in the range of 60-100% of normal.
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