Transferencia microquirúrgica del dedo del pie versus reconstrucción osteoplástica en amputación traumática del pulgar: revisión de alcance de resultados y morbilidad

Iván Darío Burbano-Obando; Juan Sebastián Rico-Diaz; Victor Manuelle Suaza-Castañeda; Daniela María Duque-Peña; Ricardo Alfonso Cabrera-Salgado; Luis Enrique Mena-Andrade; Sofía Margarita Marzan-Reyes; Derly Dayanna Vaca-Puentes; Natalia Granados-Duque; Daniela Tovar-Macias

Authors

Burbano-Obando Iván Darío Universidad de Antioquia. Medellín, Colombia. https://orcid.org/0009-0005-1600-4772
Rico-Diaz Juan Sebastián Universidad del Tolima. Ibagué, Colombia. https://orcid.org/0000-0002-9297-6072
Suaza-Castañeda Victor Manuelle Universidad de Antioquia. Medellín, Colombia. https://orcid.org/0009-0003-1435-9786
Duque-Peña Daniela María Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0003-0744-0992
Cabrera-Salgado Ricardo Alfonso Universidad Libre. Cali, Colombia. https://orcid.org/0009-0000-8053-7681
Mena-Andrade Luis Enrique Universidad Cooperativa de Colombia. Medellín, Colombia. https://orcid.org/0009-0004-5942-2045
Marzan-Reyes Sofía Margarita Universidad Libre. Cali, Colombia. https://orcid.org/0009-0007-4955-9429
Vaca-Puentes Derly Dayanna Universidad del Sinú. Montería, Colombia. https://orcid.org/0009-0003-9304-1214
Granados-Duque Natalia Universidad del Valle. Cali, Colombia. https://orcid.org/0000-0002-2495-9609
Tovar-Macias Daniela Universidad El Bosque. Bogotá, Colombia. https://orcid.org/0000-0003-4791-3029

Keywords:

Thumb, Amputation, Traumatic, Tissue Transfer, Microsurgery, Reconstructive Surgical Procedures, Treatment Outcome

Abstract

DOI: https://doi.org/10.46296/gt.v9i18.0402

Abstract

Introduction: traumatic thumb amputation caused a disproportionate loss of opposition, pinch, and manipulation. When replantation was not feasible, microsurgical toe transfer and osteoplastic reconstruction provided alternatives with different profiles of function, appearance, complexity, and donor-site morbidity. Objective: the available evidence on functional and aesthetic outcomes, complications, and donor-site morbidity of both strategies was mapped. Methods: a scoping review was conducted according to Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Indexed sources and official repositories were searched through June 2026; clinical studies, reviews, and traumatic series with separable outcomes were included. Results: fifty-six clinical sources were included in the qualitative synthesis. Toe transfer showed high survival, greater potential for sensibility, mobility, and a nail-bearing contour, but required microsurgical expertise and caused variable foot morbidity. Osteoplastic reconstruction provided length and a stable post with less dependence on microvascular resources, although sensibility, motion, and contour were less predictable and secondary procedures were frequent. Discussion: heterogeneity, retrospective case series, and scarce direct comparisons precluded a universal superiority statement. Conclusions: toe transfer appeared preferable for patients with high functional demands who accepted donor-foot risk; osteoplastic reconstruction remained useful when microsurgery was unavailable, declined, or contraindicated. Selection should be individualized and assessed with patient-reported outcomes and formal donor-site evaluation.

Keywords: Thumb, Amputation, Traumatic, Tissue Transfer, Microsurgery, Reconstructive Surgical Procedures, Treatment Outcome.

Downloads

Download data is not yet available.

References

Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. doi:10.7326/M18-0850.

Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-26. doi:10.11124/JBIES-20-00167.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.

Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:10.1080/1364557032000119616.

Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. doi:10.1186/1748-5908-5-69.

McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40-6. doi:10.1016/j.jclinepi.2016.01.021.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. doi:10.1186/s13643-016-0384-4.

Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc. 2016;104(3):240-3. doi:10.3163/1536-5050.104.3.014.

Cobbett JR. Free digital transfer. Report of a case of transfer of a great toe to replace an amputated thumb. J Bone Joint Surg Br. 1969;51(4):677-9.

Henry SL. Thumb reconstruction with toe transfer. J Hand Microsurg. 2010;2(2):72-8. doi:10.1007/s12593-010-0017-4.

Waljee JF, Chung KC. Toe-to-hand transfer: evolving indications and relevant outcomes. J Hand Surg Am. 2013;38(7):1431-4. doi:10.1016/j.jhsa.2013.03.020.

Lin PY, Sebastin SJ, Ono S, Bellfi LT, Chang KW, Chung KC. A systematic review of outcomes of toe-to-thumb transfers for isolated traumatic thumb amputation. Hand (N Y). 2011;6(3):235-43. doi:10.1007/s11552-011-9327-2.

Nagrath N, O'Neill N, Selvan D, Stevanovic M. A systematic review of the outcomes of microsurgical toe-to-hand transfer for traumatic digital reconstruction. J Hand Microsurg. 2022;14(4):287-98. doi:10.1055/s-0041-1739496.

Chung KC, Wei FC. An outcome study of thumb reconstruction using microvascular toe transfer. J Hand Surg Am. 2000;25(4):651-8. doi:10.1053/jhsu.2000.6467.

Tsai TY, Sabino J, Tsai TM, et al. Patient-reported outcome measures for toe-to-hand transfer: a prospective longitudinal study. Plast Reconstr Surg. 2019;143(4):1122-32. doi:10.1097/PRS.0000000000005422.

Kotkansalo T, Vilkki S, Elo P. Long-term functional results of microvascular toe-to-thumb reconstruction. J Hand Surg Eur Vol. 2011;36(3):194-204. doi:10.1177/1753193410387331.

Kotkansalo T, Vilkki S, Elo P. Long-term effects of toe transfers on the donor feet. J Hand Surg Eur Vol. 2014;39(9):966-76. doi:10.1177/1753193413518702.

Sosin M, Lin CH, Steinberg J, et al. Functional donor site morbidity after vascularized toe transfer procedures: a systematic review. Plast Reconstr Surg. 2016;138(4):699e-708e. doi:10.1097/PRS.0000000000002560.

Hellevuo C, Jokihaara J, Kaistila T, Leppänen OV, Vilkki SK. Long-term donor site outcome after second toe transfer for congenital hand differences. J Hand Surg Eur Vol. 2024;49(7):899-904. doi:10.1177/17531934231211569.

Yang XB, Zhao JH, Stone C. The donor foot in free toe or joint transfers. J Hand Surg Br. 2000;25(5):451-5. doi:10.1054/jhsb.2000.0454.

Gu YD, Zhang GM, Chen DS, Cheng XM, Xu JG, Zhang LY. Long-term results of toe transfer: retrospective analysis. J Reconstr Microsurg. 1997;13(6):405-8.

Woo SH, Kim JS, Seul JH. Immediate toe-to-hand transfer in acute hand injuries: overall results, compared with results for elective cases. Plast Reconstr Surg. 2004;113(3):882-92. doi:10.1097/01.PRS.0000105680.12913.28.

Ray EC, Sherman R, Stevanovic M. Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer. Plast Reconstr Surg. 2009;123(1):259-67. doi:10.1097/PRS.0b013e3181904e39.

Huang D, Wang HG, Wu WZ, et al. Functional and aesthetic results of immediate toe-to-thumb transplantation. Int Orthop. 2011;35(4):543-7. doi:10.1007/s00264-010-1044-2.

Woo SH, Lee GJ, Kim KC, Ha SH, Kim JS. Immediate partial great toe transfer for the reconstruction of composite defects of the distal thumb. Plast Reconstr Surg. 2006;117(6):1906-15. doi:10.1097/01.prs.0000209940.65331.77.

Wei FC, Chen HC, Chuang CC, Noordhoff MS. Reconstruction of the thumb with a trimmed-toe transfer technique. Plast Reconstr Surg. 1988;82(3):506-15.

Wei FC, Jain V, Chen SH. Microsurgical thumb reconstruction with toe transfer: selection of various techniques. Plast Reconstr Surg. 1994;93(2):345-51.

Wei FC, Chen HC, Chuang DC, Jeng SF, Lin CH. Aesthetic refinements in toe-to-hand transfer surgery. Plast Reconstr Surg. 1996;98(3):485-90.

Doi K, Hattori Y, Dhawan V. Wrap-around flap in thumb reconstruction. Tech Hand Up Extrem Surg. 2002;6(3):124-32.

Morrison WA, O'Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg Am. 1980;5(6):575-83.

Buncke GM, Buncke HJ, Lee CK. Great toe-to-thumb microvascular transplantation. Hand Clin. 2007;23(1):105-15. doi:10.1016/j.hcl.2006.12.004.

Gülgönen A, Ozer K, Arsenishvili A. Toe-to-hand transfers: more than 20 years follow-up of five patients. J Hand Surg Br. 2006;31(1):58-62. doi:10.1016/j.jhsb.2005.09.009.

Kvernmo HD, Haugstvedt JR, Røkkum M. Posttraumatic reconstruction of the hand: long-term results of 87 toe-to-hand transfers. J Hand Surg Am. 2011;36(7):1176-81. doi:10.1016/j.jhsa.2011.04.010.

Venkatramani H, Sabapathy SR. Functional outcomes of post-traumatic metacarpal hand reconstruction with free toe-to-hand transfer. Indian J Plast Surg. 2016;49(1):16-25. doi:10.4103/0970-0358.182236.

Sabapathy SR, Venkatramani H, Bharathi RR, Sebastin SJ. Reconstruction of thumb amputation at the carpometacarpal joint level by groin flap and second toe transfer. Injury. 2013;44(3):370-5. doi:10.1016/j.injury.2012.12.026.

Troisi L, Berner JE, Pompei B, et al. Beauty and function: the trimmed great toe transfer for thumb reconstruction. Plast Reconstr Surg Glob Open. 2022;10(9):e4540. doi:10.1097/GOX.0000000000004540.

Yin Y, Zhang R, Li S, et al. Cosmetic and functional results of thumb reconstruction using a combined second-toe phalanx and great toenail flap. Medicine (Baltimore). 2020;99(40):e22452. doi:10.1097/MD.0000000000022452.

Nakamoto HA, Barbieri CH, Mazzer N, et al. Transfer of the second toe for traumatic thumb amputation in a four-year-old child: a case report. Rev Bras Ortop. 2024;59(4):632-6. doi:10.1055/s-0042-1744518.

Ghosh K, Fufa DT, et al. Second toe-to-thumb transfer using intramedullary screw fixation. J Hand Surg Glob Online. 2024;6(4):529-34. doi:10.1016/j.jhsg.2024.05.003.

Wolff G, Posso C, Second-toe transfer for traumatic thumb amputation in children under 5 years: bone and soft-tissue growth. Tech Hand Up Extrem Surg. 2014;18(4):175-80. doi:10.1097/BTH.0000000000000063.

Jones NF, Clune JE. Thumb amputations in children: classification and reconstruction by microsurgical toe transfers. J Hand Surg Am. 2019;44(6):519.e1-519.e10. doi:10.1016/j.jhsa.2018.08.017.

Li B, Yang J, Chen J, et al. Effect of second toe-to-hand transfer on plantar pressure distribution of the donor foot. Int J Clin Exp Med. 2016;9(2):3348-55.

Lipton HA, May JW Jr, Simon SR. Preoperative and postoperative gait analyses of patients undergoing great toe-to-thumb transfer. J Hand Surg Am. 1987;12(1):66-9.

Barca F, Santi A, Tartoni PL, Landi A. Gait analysis of the donor foot in microsurgical reconstruction of the thumb. Foot Ankle Int. 1995;16(4):201-6. doi:10.1177/107110079501600405.

Beyaert C, Henry S, Dautel G, Martinet N, Paysant J, André JM. Effect on balance and gait secondary to removal of the second toe for digital reconstruction: 5-year follow-up. J Pediatr Orthop. 2003;23(1):60-4.

Segu SS, Athavale SN, Manjunath P. Osteoplastic reconstruction for post traumatic thumb amputations around metacarpophalangeal joint. J Clin Diagn Res. 2015;9(8):PC11-PC13. doi:10.7860/JCDR/2015/14334.6404.

Liu Y, Miller EA, Hacquebord JH. Osteoplastic thumb reconstruction in the immediate setting: a case series. Plast Reconstr Surg Glob Open. 2022;10(6):e4385. doi:10.1097/GOX.0000000000004385.

Lin CH, Wei FC, Lin YT, et al. Osteoplastic thumb ray restoration with or without secondary neurovascular island flap. Plast Reconstr Surg. 2008;121(4):1288-96. doi:10.1097/01.prs.0000305532.22786.3f.

Sabapathy SR, Bhardwaj P, Venkatramani H. Functional evaluation of great toe transfer and the osteoplastic technique for thumb reconstruction in the same individual. J Hand Surg Br. 2003;28(5):405-8. doi:10.1016/S0266-7681(03)00108-6.

Cheema TA, Miller S. One-stage osteoplastic reconstruction of the thumb. J Hand Surg Am. 2009;34(7):1313-7. doi:10.1016/j.jhsa.2009.03.026.

Parmaksizoglu F, Beyzadeoglu T. Composite osteocutaneous groin flap combined with a neurovascular island flap for thumb reconstruction. J Hand Surg Br. 2003;28(5):399-404. doi:10.1016/S0266-7681(03)00106-2.

Parvizi D, Friedl H, Schintler MV, et al. Analysis of functional outcome after posttraumatic thumb reconstruction. Wien Klin Wochenschr. 2012;124(7-8):241-6. doi:10.1007/s00508-012-0151-7.

Muzaffar AR, Chao JJ, Friedrich JB. Posttraumatic thumb reconstruction. Hand Clin. 2005;21(4):495-503. doi:10.1016/j.hcl.2005.08.001.

Graham DJ, Venkatramani H, Sabapathy SR. Secondary thumb reconstruction in a mutilated hand. Hand Clin. 2016;32(4):533-47. doi:10.1016/j.hcl.2016.07.006.

del Piñal F. Extreme thumb losses: reconstructive strategies. Plast Reconstr Surg. 2019;144(3):665-77. doi:10.1097/PRS.0000000000005926.

Engdahl R, Morrison N. Traumatic thumb amputation: case and review. Eplasty. 2015;15:ic11.

Gabotto Loredo N, et al. Osteoplastic reconstruction of the thumb: technique and outcomes after more than 6 years. Rev Asoc Argent Ortop Traumatol. 2025;90(6):570-7. doi:10.15417/issn.1852-7434.2025.90.6.2030.

Hanawi M, Alshomer F, Alkhayal A, et al. Successful non-microsurgical thumb reconstruction using skeletonized amputated phalanges after failed replantation. Cureus. 2022;14(12):e32737. doi:10.7759/cureus.32737.

Shrestha N, Shrestha D, et al. Acute thumb reconstruction with iliac crest bone graft and groin flap: a case report. Int J Surg Case Rep. 2023;109:108506. doi:10.1016/j.ijscr.2023.108506.

Budi DPS, et al. Iliac crest bone graft with radial forearm flap for thumb reconstruction: a case report. Int J Surg Case Rep. 2024;116:109410. doi:10.1016/j.ijscr.2024.109410.

Martinez DES, et al. Immediate thumb reconstruction using a reverse radial forearm flap after traumatic amputation. Plast Reconstr Surg Glob Open. 2024;12(10):e6231. doi:10.1097/GOX.0000000000006231.

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH. Am J Ind Med. 1996;29(6):602-8. doi:10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L.

Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998;23(4):575-87. doi:10.1016/S0363-5023(98)80042-7.

Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, Howard LA. An objective and standardized test of hand function. Arch Phys Med Rehabil. 1969;50(6):311-9.

Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69-74.

Kapandji A. Clinical test of apposition and counter-apposition of the thumb. Ann Chir Main. 1986;5(1):67-73. doi:10.1016/S0753-9053(86)80053-9.

MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. 1998;12(8):577-86.

Lundborg G, Rosén B. The two-point discrimination test-time for a re-appraisal? J Hand Surg Br. 2004;29(5):418-22. doi:10.1016/j.jhsb.2004.02.008.

Robbins F, Reece T. Hand rehabilitation after great toe transfer for thumb reconstruction. Arch Phys Med Rehabil. 1985;66(2):109-12.

Donnelly MR, et al. Pollicization versus toe-to-thumb transfer for traumatic thumb amputation: an international multicenter survey study. J Hand Surg Glob Online. 2024;6(1):35-42. doi:10.1016/j.jhsg.2023.10.006.

Shaffrey EC, Cason RW, Park JW, et al. Forty-year follow-up after great toe-to-thumb transfer: a case report. J Hand Surg Glob Online. 2023;5(3):375-8. doi:10.1016/j.jhsg.2023.01.009.

Raizman NM, Klieger SB, Light TR. Long-term donor-site morbidity after free, nonvascularized toe phalanx transfer. J Hand Surg Am. 2020;45(2):159.e1-159.e7. doi:10.1016/j.jhsa.2019.05.026.