ABSTRACT
Although it has been established that a single lost hand can be reconstructed by autogenous
bilateral toe transplantation, the problem of how to reconstruct bilateral hand loss
still remains. The authors present a novel approach to solve this intricate problem.
A big toe free skin-nail flap, along with the second digital ray or second and third
digital rays, with a common vascular pedicle, is taken from the donor foot and transferred
to the forearm stump by microsurgical technique, thereby creating a hand with two
or three digits. Either a piece of the iliac bone or an ulna block cut during the
preparation of the forearm stump is used to substitute for the lost first metacarpus
and phalanges of the thumb. The operative technique is described. Three patients have
undergone this procedure and have had both lost hands reconstructed. Among the six
reconstructed hands, two had two digits in each and the others had three digits. One
reconstructed hand failed to survive subsequent to vascular thrombosis which might
have been due to degeneration and thickening of the vessel wall. Partial failure occurred
in another, where the transferred big toe skin-nail flap necrosed and was replaced
by a pedicled skin tube. All five surviving hands were followed up for more than one
year and showed satisfactory functional recovery.
