Since the introduction of microsurgical toe-to-hand transfers, much has been learned about the indications for the procedure. In addition, many technical variations and modifications have been described (Table 9.2) to solve problems and to address specific clinical needs.
Table 9.2. Described techniques for microvascular digital reconstruction
Second toe transfer with dorsalis pedis flap Partial toe transfers Trimmed toe transfer Wrap around flap Extended wrap around flap Toe pulp transfer Vascularized nail graft
Great toe partial nail preserving technique Combined transfers
Combined second and third toe transfer
Wrap around flap plus second toe proximal phalanx
Pollicised index finger stump plus lateral arm flap Pedicled groin flap plus toe transfer Osteocutaneous lateral arm flap Transfers including epiphyseal plates Unusual cross hand finger transfers Cross hand ring finger transfer Transfer of damaged or abnormal digits Polydactylous toe transfer
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