Functional outcome of multiple toe transfer procedure for open multiple transmetacarpal amputation secondary to a crushing injury: A case report.

introductionReconstruction for open multiple transmetacarpal amputation secondary to a crushing injury is really challenging. Some treatment approaches could be proposed. To avoid the drawbacks of a prosthesis and hand transplantation such as the high cost, and long-term side effects of anti-rejection drugs, toe transfers were chosen. PRESENTATION OF CASE: A 33 year-old man suffered a crushing injury that led to a left transmetacarpal amputation and a right arm amputation. The left hand was reconstructed by toe transfers to restore the thumb, index and middle fingers. After 75 months of follow-up, on the left hand, the patient could recover tripod pinch. Tripod pinch strength was 4 pounds, grip strength was 10 pounds. Static 2 points discrimination of the reconstructed thumb, index, and middle fingers was 12, 13, and 15 mm, respectively. The maximum grip span was 8 cm. With the left reconstructed hand, the patient could return to almost all activities in daily life and work. DISCUSSION: For this case, toe transfers seems to be more suitable and effective than other methods. Tripod pinch reconstruction provides stability, a strong grip, a wide working-distance, and a good appearance.

conclusionThis case highlights the efficacy of tripod pinch reconstruction by toe transfers in addressing complex transmetacarpal amputation, providing effective solution even when the contralateral upper extremity was also amputated.