Quality of life in patients with toe-to-hand transplantation

Abstract

Objective: Toe-to-hand transplantation is a reliable procedure that replaces like-with-like in cases of a lost thumb or finger. The aim of this study is to investigate the effects of toe transplantation on patients from the perspectives of quality of life (QOL) and disability. Methods: Ten patients with traumatic amputation of a digit underwent reconstruction with toe transplantation. The mean age at injury was 40.2 years (range 17–59 years). Reconstructive options were 5 wrap-around flaps to 2 thumbs and 3 index fingers; 2 second-toe transplantations to 2 middle fingers, and 3 hemipulp-free flaps from the great toe to a thumb and an index finger. We hypothesized that toe transplantation would improve postoperative QOL and disability. Outcome assessments included completion of the SF-36, SAFE-Q, and DASH questionnaires before and after reconstruction. Scores on each test were calculated and intra-individual comparisons were made. Results: All scores for the eight SF-36 health domains improved, with a significant difference in Vitality from before to after surgery. In contrast, scores for all five SAFE-Q items worsened, with significant changes for the ‘Pain and Pain-Related’ and ‘Physical Functioning and Daily Living’ subscales. DASH scores improved after surgery in all cases. Conclusions: Our results suggest that toe-to-hand transplantation for amputated finger reconstruction is a good option in terms of improved QOL. However, worsened SAFE-Q scores imply that donor site problems could be expected and must be taken into account during surgical planning.

Keywords:

• toe transplantation
• quality of life
• disability
• foot morbidity

Disclosure statement

No potential conflict of interest was reported by the authors.