A recent study highlights the potential for toe transfer surgery to surpass attempted replantation in restoring hand function after digital amputation.
The research offers compelling long-term comparative data supporting this procedure, particularly in scenarios where replantation is unsuccessful or unfeasible.
Analysing outcomes from 126 toe transfer procedures versus 96 re-implantations across 75 and 52 patients, respectively, the study’s cohorts were evaluated at a minimum of five years post-operation.
Results demonstrated significantly higher hand function scores in the toe transfer group, with improvements approximately three times greater than the clinically meaningful threshold.
These benefits were correlated with improved physical health-related quality of life, as measured by SF-36 scores, with foot function remaining at normative levels.
Key predictors of improved hand outcomes included hand range of motion, tripod pinch strength, and two-point discrimination, as well as overall health metrics.
While prior literature reports high surgical success rates for toe transfers, this study is notable for its validated assessment of functional outcomes, filling a critical gap in evidence-based guidance.
Dr Fu-Chan Wei of Chang Gung Memorial Hospital led the study.
He and Steven Lo suggest that these findings challenge current paradigms, which favour emergency replantation as the default approach, proposing that toe transfer should be regarded as a viable and preferable alternative in specific cases.
Implementing this strategy within national healthcare frameworks could significantly mitigate disability burdens associated with finger and thumb amputations, addressing a significant public health concern.
The write: ‘These data provide the first evidence for the potential functional superiority of toe transfers over replantation in digital amputation using one of the largest validated outcome datasets of toe transfers to date.’
They believe their findings challenge the assumption that emergency replantation should always be the gold standard after digital amputation.
Additionally, they suggest that the toe transfer can be considered ‘a viable alternative’ for some patients.
Integrating toe transfers into national healthcare frameworks has the potential to positively address one of the single most significant causes of disability worldwide.
Amputations of the fingers and thumb are common injuries, affecting about 45,000 people per year in the US alone.
Digit amputations can leave patients with years of disability, especially if the thumb is lost. Emergency replantation of the amputated digit is the current standard of treatment, but it can be impossible or unsuccessful.
While toe transfer surgery is not a new procedure, few studies have evaluated its impact on hand function and other patient-reported outcomes.
