Second Toe Transfer and “Tandem” Free Flap for Radial Hand Injuries with Thumb Loss

Abstract

Materials & Methods

Eleven cases of thumb loss and skin defect in the radial aspect of the hand underwent a simultaneous free flap cover and second toe transfer. Seven were emergency and four were elective. Nine of the flaps were the anterolateral thigh (ALT) flap and two were extended versions of the lateral arm flap. The mean area of tissue defect needing replacement with the free flap was 110 cm2. All the toe transfers used the second toe. The flap revascularization preceded that of the toe.

Results

The descending branch artery of the ALT flap or a branch of the radial artery, if present, was used to revascularize the transferred toe. The venous anastomosis to the flap and the toe used a combination of the superficial veins and venae comitantes of the radial pedicle. Though there were two re-explorations, only one transferred toe was lost.

Discussion

Among the ten patients who were evaluable at follow up, the opposition as measured by the mean Kapandji score was 6.

Conclusion

All patients had useful grasp and thumb pinch. Secondary procedures like flap thinning and tenolysis were done in seven cases.

Keywords

second toe transfer - free flap - thumb amputation - thumb reconstruction

Patients' Consent

The patients have provided written informed consent for the use of their clinical information and images.

Ethical Approval

This is a retrospective study based on case records, with no reference to patient identity in the text or images. A waiver of informed consent has been sought.

Publikationsverlauf

Artikel online veröffentlicht:
13. August 2025

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