Microneurosurgical Planning in Toe-to-Hand Transplantation: Axonal Population of Digital Nerves in the Fingers and Toes

Abstract

Although toe-to-hand microvascular transplantation is now an accepted and successful reconstructive strategy for the thumb, there remains varying success in recovery of sensibility. The purpose of the present study was to provide an anatomic basis for analyzing neurotization of the great toe or the second toe with the digital nerves of the fingers and hand. Axon counts were obtained from donor and recipient nerves during reconstructive procedures. Sixty-seven upper- and eighty lower-extremity nerves were analyzed. No statistical difference was found between the mean number of axons between the thumb and the index finger; however, the thumb had significantly more (p < 0.001) axons than the middle or the ring finger. The great toe had significantly more axons than the second toe (p < 0.001). The common plantar digital nerve had significantly more axons than a digital nerve (p < 0.001). The thumb had significantly more axons than the great toe (p < 0.001). The thumb had significantly more axons than the second toe (p < 0.001). Numerical data are now available for strategic planning of toe transplantation, and direct neurotization from the dorsum of the hand to the digits.

Keywords

toe-to-thumb - digital nerve - nerve fiber count - sensory reeducation

• References

• 1 Buncke HJ. Toe digital transfer. Clin Plast Surg 1976; 3: 49-57
• 2 Foucher G, Merle M, Maneaud M, Michon J. Microsurgical free partial toe transfer in hand reconstruction: a report of 12 cases. Plast Reconstr Surg 1980; 65: 616-627
• 3 Leung PC. Transplantation of the second toe to the hand. A preliminary report of sixteen cases. J Bone Joint Surg Am 1980; 62: 990-996
• 4 Harii K. Microvascular Tissue Transplantation. Tokyo: Igaku-Shoin; 1983
• 5 Minami A, Usui M, Katoh H, Ishii S. Thumb reconstruction by fee sensory flaps from the foot using microsurgical technique. J Hand Surg [Br] 1984; 9B: 239-244
• 6 Wei FC, Chen HC, Chuang CC, Noordhoff MS. Reconstruction of the thumb with a trimmed-toe transfer technique. Plast Reconstr Surg 1988; 82: 506-515
• 7 Wei FC, Chen HC, Chuang DC, Chen S, Noordhoff MS. Second toe wrap-around flap. Plast Reconstr Surg 1991; 88: 837-843
• 8 Mochert J, Raff T. [Secondary thumb reconstruction after avulsion or amputation injury with free wrap-around toe flap]. Handchir Mikrochir Plast Chir 2008; 40: 115-121
• 9 Zhao J, Tien HY, Abdullah S, Zhang Z. Aesthetic refinements in second toe-to-thumb transfer surgery. Plast Reconstr Surg 2010; 126: 2052-2059
• 10 Wei FC, Chen HC, Chuang CC, Noordhoff MS. Simultaneous multiple toe transfers in hand reconstruction. Plast Reconstr Surg 1988; 81: 366-377
• 11 Wei FC, Colony LH, Chen HC, Chuang CC, Noordhoff MS. Combined second and third toe transfer. Plast Reconstr Surg 1989; 84: 651-661
• 12 Poppen NK, Norris TR, Buncke Jr HJ. Evaluation of sensibility and function with microsurgical free tissue transfer of the great toe to the hand for thumb reconstruction. J Hand Surg Am 1983; 8 (5 Pt 1) 516-531
• 13 Robbins F, Reece T. Hand rehabilitation after great toe transfer for thumb reconstruction. Arch Phys Med Rehabil 1985; 66: 109-112
• 14 Dellon AL. Sensory recovery in replanted digits and transplanted toes: a review. J Reconstr Microsurg 1986; 2: 123-129
• 15 Dellon AL. Evaluation of Sensibility and Re-Education of Sensation in the Hand. Baltimore: Williams and Wilkins; 1981
• 16 Wei FC, Ma HS. Delayed sensory reeducation after toe-to-hand transfer. Microsurgery 1995; 16: 583-585
• 17 Hammarback JA, Palm SL, Furcht LT, Letourneau PC. Guidance of neurite outgrowth by pathways of substratum-adsorbed laminin. J Neurosci Res 1985; 13: 213-220
• 18 Clark SA, Allard T, Jenkins WM, Merzenich MM. Receptive fields in the body-surface map in adult cortex defined by temporally correlated inputs. Nature 1988; 332: 444-445
• 19 Dellon AL. Somatosensory Testing and Rehabilitation. Rockville, MD: American Occupational Therapy Assoc; 1994
• 20 Ma HS, Abdalla el-Gammal T, Wei FC. Current concepts of toe-to-hand transfer: surgery and rehabilitation. J Hand Ther 1996; 9: 41-46
• 21 Wei FC, Carver N, Lee YH, Chuang DC, Cheng SL. Sensory recovery and Meissner corpuscle number after toe-to-hand transplantation. Plast Reconstr Surg 2000; 105: 2405-2411
• 22 Ducic I, Dellon AL, Bogue DP. Radial sensory neurotization of the thumb and index finger for prehension after proximal median and ulnar nerve injuries. J Reconstr Microsurg 2006; 22: 73-78
• 23 Maloney Jr CT, DeJesus R, Dellon AL. Painful foot neuromas after toe-to-thumb transfer. J Hand Surg Am 2005; 30: 105-110
• 24 Dellon AL, Maloney Jr CT. Salvage of sensation in a hallux-to-thumb transfer by nerve tube reconstruction. J Hand Surg Am 2006; 31: 1495-1498
• 25 Mackinnon SE, Dellon AL, O'Brien JP , et al. Selection of optimal axon ratio for nerve regeneration. Ann Plast Surg 1989; 23: 129-134