Toe to thumb transplant for hand reconstruction

California Pacific's Microsurgery Department at the Davies Campus has been performing toe-to-thumb transplant or transfer surgeries since 1972 and has over 40 years of experience. Great toe or second toe transplantation can be performed for reconstruction of congenital anomalies and traumatic loss of the thumb.

The thumb is responsible for about 50% of the hand's function and agility. Toe-to-thumb transplantation can restore both aesthetic and functional loss to the hand with little loss of function to the foot. The human thumb is unique in that it is opposable -- it has the ability to touch each fingertip of the same hand. Simply picking up and grasping objects, and fine motor skills are all made possible by the opposing thumb.

The hand and foot have many common features; the great toe is particularly suitable to replace a missing thumb and restoring strong opposable function. Although somewhat wider than the thumb, the transplanted great toe decreases in size up to one third when transplanted to the hand.

Microsurgery makes it possible to connect small arteries, veins and nerves that are necessary for successful digital and other free tissue transplants.

Case examples:
Toe to thumb reconstruction for congenital anomalies
A three-year-old child with congenital absence of all fingers of her right hand received two second toe transplants, establishing critical pinch and grasp.

Toe to thumb transplant for loss due to accident
A young woman lost her thumb in a water skiing accident. Great toe to hand transplantation restores the function of the hand with unmatched aesthetic result.

A 24-year-old right-handed woman who caught her thumb in a conveyer belt. The patient underwent a right great toe-to-thumb transplant and required secondary operations to the rest of her hand for scar release.
Read more about this case in Pioneering Microsurgery: Offering Hope to Traum Victims.

History & Surgical Firsts

Dr. Harry Buncke and his colleague performed the first toe to thumb transplant in the rhesus monkey in 1964.

It was at Davies Medical Center, now known as the Davies Campus of California Pacific Medical Center, that Dr Buncke successfully performed the first great toe-to-thumb transplant in the United States in 1972 on a firefighter who lived in San Francisco.

In 1995, the Buncke team perfromed the first four finger and thumb reconstruction with toe transplants to the dominant hand.

Read more about:

• Dr Harry Buncke, MD
• Microsurgical Procedures
• Pediatric Microsurgery: Plastic and Reconstructive Surgery for Children

Publications

1. Chapter 1: Great Toe TransplantationOpens new window in Microsurgery: Transplantation and Replantation: An Atlas Text. Harry J. Buncke, MD (editor). Lea & Febiger, 1991.


2. Immediate Nicolandoni procedure in the Rhesus monkey. Buncke HJ, Buncke CM, Schultz WP.Opens new window Br J Plast Surg 1966;19:332–41.


3. Toe digital transfer. Opens new windowBuncke HJ. Clin Plast Surg. 1976 Jan;3(1):49-57.


4. Thumb replacement: great toe transplantation by microvascular anastomosis. Opens new windowBuncke HJ Jr, McLean DH, George PT, Creech BJ, Chater NL, Commons GW. Br J Plast Surg. 1973 Jul;26(3):194-201.


5. Great toe transplant versus thumb replant for isolated thumb amputation: critical analysis of functional outcome. Opens new windowRosson GD, Buncke GM, Buncke HJ. Microsurgery. 2008;28(8):598-605.


6. Great toe-to-thumb microvascular transplantation after traumatic amputation.Opens new window Buncke GM, Buncke HJ, Lee CK. Hand Clin. 2007 Feb;23(1):105-15. Review.