Causes of necrosis of the donor great toe in toe-to-hand transfer and its preventive measures

Abstract

Objective To analyze the causes of necrosis of the donor great toe in 3 eases of toe-to-hand transfer and propose the proper preventive measures. Methods Among all the toe-to-hand transfers done from February 1998 to February 2005, partial necrosis of the donor great toe occurred in 3 cases. Blood supply of the transferred toe and the intraoperative vessel occlusion test was reviewed and analyzed to define causes of the necrosis, and propose preventive measures accordingly. Results The dorsal artery of the great toe was type Ⅲ in all 3 cases. Intraoperatively the second toe was harvested based on the dorsalis pedis artery, deep plantar artery, plantar artery of the first toe. Donor great toe necrosis was observed 8 to 21 hours postoperatively. Intraopemtive inadvertent injury of the dorsal great toe fibular artery and fibular plantar metatarsal artery, tight dressing of the donor site after the surgery, and poor postoperative monitoring could have contributed to the toe necrosis. Conclusion Type Ill of the dorsal artery of the great toe, anatomical X cross and resection of the second toe could easily affect blood supply to the donor great toe. Anastomosis of the deep plantar artery and the plantar metatarsal artery, or harvest of the toe based on the dorsalis pedis artery, second dorsal metatarsal artery, digital artery axis can effectively prevent damag of the blood flow. Intra-and post-operative close monitoring of the donor site circulation and timely decompression of the great toe were effective ways to prevent great toe Key words: Hallux; Transplantation; Necrosis; Thumb reconstruction; Preventive measures