Microsurgical Digital Reconstruction Indications and Technical Options

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

Great toe transfer Second toe transfer

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

Twisted toe flap

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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