[How modern is modern hand surgery?].
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Biomedical subjects
Publications and source records attributed to R Schiewe.
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Following amputation of all four fingers from the hand, the cover of the amputation site with an abdominal flap gives a hand which is functionally inferior. This paper reports our experiences of three toe transfers to such a hand in two patients, one a 22-year-old man, the other, a 50-year-old woman. In our opinion, the toe transfer will be successful if the vessels, nerves and tendons are harvested to the level of the extensor retinaculum, giving a length in excess of the skeleton of some 12-15 cm. The routing of these structures beneath the abdominal flap is done in such a way as to avoid any ischemia and therefore, infection. In the first case, these latter considerations were not fully observed and in the third postoperative week, arterial thrombosis with loss of the transfer developed, following an infection. The two other transposed digits have survived with a good functional result.
Today toe-to-hand transfer by micro-anastomoses is one of the most important methods in reconstructing severely injured hands. An experienced surgeon will obtain a survival rate of the transplant in about 94 to 96% of cases. All measures required can be performed by only one operation. The free toe-to-hand transfer guarantees the best functional and aesthetic results so far known.
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