04 Original2544 IN.qxp (15-24)

15 Introduction. Multidigital amputations are a formidable challenge for the surgeon. In the case of amputations near the digital commissure the best reconstruction can be achieved using a combined flap of the 2nd and 3rd toes. The aim of this study is to present the functional results achieved in 5 patients who underwent combined 2nd and 3rd toe transplants to rehabilitate severely mutilated hands. Materials and methods. Since 1995 we performed 95 toeto-hand transplants with a survival rate of 94/95. Five pa,,,,tients (ages 21–53 years) that had suffered amputations of 5 fingers (3 cases), and 4 fingers (2 cases), underwent 2nd and 3rd toe flap combined transplants. All were operated on during the acute or subacute phase. Four of the patients that had suffered a thumb amputation underwent reconstruction by means of a big toe transplant in 3 cases and emergency ectopic middle toe reimplantation in 1 case. Thumb reconstruction was considered a priority and performed one week before the toe flap tandem transplants. Results. All the transplants survived. Minimum postoperative followup was 6 months. In all cases at least one stable tripod pincer grasp was achieved. As to the foot, there were no cases of toe crossover, permanent pain during gait or manifest functional impairment. The objective survey on cosmetic sequelae revealed that these were important to us but not so important for the patients. The patients would all choose to undergo the operation again and would advise other patients in the same situation to have this type of surgery. Conclusions. The complexity involved in the reconstruction of a metacarpal hand implies consideration of such issues as the position and number of toes to be transplanted and the management of associated tissue loss and blood supply. The combined transplant of the 2nd and 3rd toes allows recovery of a tripod pincer grasp and results in a high degree of patient satisfaction. The greater cosmetic sequelae are offset, in our opinion, by the greater pincer grasp stability. This type of surgery is recommended for patients that have suffered amputations of three fingers with three phalanges proximal to the commissural fold.