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

Introduction: Reconstruction 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.

Conclusion: This 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.