TOE-TO-HAND TRANSFERS IN THE REHABILITATION OF FROSTBITE INJURY

In our experience digitless hands from frostbite injury are typically seen in young men as a result of an episode of intoxication. Such deformities occur bilaterally in 80% of cases and often lead to total loss of prehensile capability. Because of a uniformly high degree of motivation in this group of patients, toe-to-hand transfer carries an excellent prognosis. Microanastomoses in a frost-bitten hand are as reliable as in a mechanically injured hand, provided the ulnar artery and its branches are intact. Because amputations occur at the level of the metacarpal heads, the preferred transplant is the combined second and third toe composite. However, a satisfactory thumb post is essential for proper function of the composite. Well-planned sharing of available toe resources is necessary for establishing optimum bilateral hand function, especially in the face of simultaneous toe frostbite. Squandering valuable foot resources bilaterally on behalf of a single hand makes reconstructing the opposite hand more difficult. Economy may be gained if two separate microvascular toe transfers are taken from the same foot or if a single block of toes may be applied to the hand as an opposable unit. Clinical management is described of 25 digitless patients whose frost-bitten hands were treated by microsurgical toe transfer.