Treatment of monodactyly in adults with bilateral free second toe transplantation

Objective To evaluate the application of bilateral second toe transfer for reconstruction of congenital monodactyly in adults.Methods Five adult patients with congenital monodactyly were treated between January 2000 and October 2011 by transferring second toes from both feet to reconstruct the index and middle fingers.All 5 patients showed that only one hand was involved with a near normal thumb and no fingers.Postoperative evaluations included range of motion,moving two-point discrimination,grip strength,key pinch,Jebsen-Taylor hand assessment and patient questionnaire on appearance.Results The patients were follow-up after the surgery for 14 months to 6 years.All the transplants survived.Protective sensation was restored in all the reconstructed fingers.Range of motion was 12° at the distal interphalangeal joint,22° at the proximal interphalangeal joint and 74° at the metacarpophalangeal joint.Grip strength and key pinch were 25.5 ％ and 74.5 ％ of the contralateral hand respectively.Jebsen-Taylor hand assessment indicated that the involved hand could manage basic activities.The average visual analogue score (VAS) was 8.Conclusion Bilateral second toe transfer is a valid procedure for finger reconstruction in adults with congenital monodactyly. Key words: Hand deformities, congenital;  Tissue transplantation;  Adults