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Toe-to-Finger Transfer

At The Center for Hand and Upper Extremity Surgery, our surgeons are experts in treating traumatic hand injuries. Hand reconstruction may be achieved by using replantation surgery, as well as toe-to-finger transplants, which may help patients regain use of their fingers following a traumatic injury.


When may a toe-to-finger transplant be performed?

In some cases, a detached finger may be unsalvageable, making it impossible to reattach. If a hand injury leads to a finger that cannot or should not be reattached, our surgeons may be able to clean, smooth and cover the cut end with a finger amputation procedure. In some cases, this option will give you a better and faster recovery than reattaching the body part. Once the hand has healed, patients may be interested in undergoing a toe-to-finger transplant to improve hand function.


What is a Toe-to-Finger transplant?

A transplant is a common surgical procedure, which involves taking tissue (bone, skin, nerves, etc.) from one area of a patient’s body and transferring it to another area of the body to improve form or function. A Toe-to-Finger transplant is a unique surgical intervention that restores function to the hand by removing a toe and transplanting it to the hand to replace a missing finger. This is a complex surgical procedure which transfers the blood vessels, bones, tendons and nerves of the toe. This procedure can improve hand function by restoring the ability to perform pinch grip.


What does the procedure entail?

This procedure is done under general anesthesia. The toe that will be transferred is removed from the foot along with its own blood vessels, nerves, bone and tendons. Selection of a donor toe is dependent on which finger is being replaced. Most commonly, the second toe (toe next to the big toe) is used for this procedure. In some cases, the big toe may be used. Once the area where the toe was taken from is closed, the surgeon will then begin connecting the toe to the hand in the area of the missing finger. A microscope is needed to connect the tiny blood vessels and nerves between the toe and hand.


 What is recovery like?

Following the initial healing period, rehabilitation is essential to achieve maximal function of the hand. Light activity of the hand may begin a few days after the procedure, followed by gradual integration of active therapy exercises and strengthening activities. Sensory rehabilitation is also needed once the nerves have healed and sensation begins to return to the transferred toe (usually 3-6 months after surgery). We are proud to work closely with hand therapists to create a comprehensive therapy plan following your surgery. Our surgeons believe that the successful outcome of any toe-to-finger transfer is 50% related to the surgical repair and 50% dependent on a patient’s dedication to recovery, including post-operative therapy.

What are the potential benefits of this procedure?

Following a finger amputation, patients may experience functional limitations with their hand and may be unpleased with the aesthetic appearance of their hand. A toe-to-finger transfer can improve function of the hand, making everyday activities easier and in some cases, allowing patients to return to work. While the main goal of this procedure is to improve function, some patients also report increased satisfaction with the appearance of their hand. The defect that is created in the donor foot has not been found to produce significant aesthetic or functional alterations.