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Thumb Replacement / Reconstruction Using A Transplanted Toe

EnolaGaia

I knew the job was dangerous when I took it ...
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This procedure has been used for more than 50 years. This news article describes how it was a perfect recovery strategy for a cobbler who'd lost his thumb.
In rare surgery, hospital swaps man's lost thumb for a big toe

The cobbler thought he'd never work again, but the strange surgery saved his hand function.

A cobbler lost his thumb while trimming the heel of a shoe, but thankfully, surgeons were able to replace the missing digit with one of the man's big toes.

Master cobbler David Lee lost his thumb on Jan. 9, 2019, just six weeks after moving his cobbling business to a new location.

"Straight away, I knew how bad it was, and I just worried that I wouldn't be able to fix shoes again," Lee said in a statement. "I cried my eyes out when I thought about it, as I thought I was going to lose my shop."

But after being referred to Royal Derby Hospital in Derby, England, Lee learned that his thumb could be replaced using a rare procedure called "toe-to-thumb reconstruction."

"There are lots of different ways to reconstruct thumbs, but using the big toe gives the best functional and cosmetic benefits, as it is the thing most like a thumb on the body," Jill Arrowsmith, one of the hand surgeons who performed Lee's operation, said in the statement. Surgeons offer the procedure only to patients who have lost most of the thumb, "usually down to the knuckle," Arrowsmith added.

"As soon as it was put to me that attaching my toe gave me a chance to carry on my job, I instantly said let's do it," Lee said.

Toes serve as a near perfect substitute for fingers because both digits share a similar structure and range of motion, as well as sensitive skin and nails for pinching, according to a 2010 report in the Journal of Hand and Microsurgery. For patients that lose their entire thumb, only a full toe transfer can provide them "optimal rather than adequate function." Either the big toe or second toe can be used for the transfer, although the bulbous big toe better matches a thumb's appearance and function.

Removal of the big toe does leave an obvious deformity in the donor foot and can reduce the patient's power when pushing off from the floor, but generally, patients continue to walk normally after the procedure. ...

Lee underwent the procedure five days after his accident, and the operation took 10 hours to complete. ...

"Now, a year on, I'm back in the shop and doing what I love again," Lee said in a video released by the hospital.
FULL STORY (With Photos): https://www.livescience.com/mans-lost-thumb-replaced-with-big-toe.html
 
This 2014 article from The Atlantic describes another patient's toe / thumb transplant experience and provides the following excerpt about the history of the procedure.

In 1897 Austrian surgeon Carl Nicoladoni performed the first toe-to-thumb in humans by connecting a man’s hand to his foot at the base of the great toe. After the patient spent weeks bent over with hand locked to toe, Nicoladoni cut the great toe from the foot and left it attached to the man’s hand, thus creating the world’s first “thoe,” as they are sometimes now called. Nicoladoni’s patient was left without major nerves, but the doctor showed it could be done.

Today, surgeons around the country perform the same operation far more successfully—and without forcing the patient to spend weeks hunched over. Rosen has performed two dozen toe-to-thumb transfers since 1983. Now, a professor of surgery and associate professor of engineering at Dartmouth-Hitchcock, Rosen studied with Dr. Harry Buncke, known to many as the father of microsurgery, who performed the first microsurgical toe-to-thumb transfer on monkeys in 1966.

SOURCE: https://www.theatlantic.com/health/archive/2014/10/the-surgeons-who-make-toes-into-thumbs/381362/
 
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Doesn't the loss of the big toe cause problems with walking? He's swapping one disability for another.

The degree of balance and striding deficiencies caused by loss of the big toe have been greatly exaggerated - to the point it's considered something of a myth.

It requires some adaptation, and adjustment can be facilitated with orthopedic shoes or other measures.

Bottom Line: The minor impairment(s) induced by losing the toe pale by comparison with the impairment of losing a thumb and the ability to firmly grasp objects with the affected hand.

Here's a 2007 summary from a Scientific American article on the myth ...

A nine-toed gait is less efficient, slower and shorter, but no less effective. "You're going to look choppier," Dugan says. Although running on fewer toes takes some getting used to, people can modify their style, train their muscles and practice balance exercises to compensate for a lost toe.

From a functional standpoint, amputating a big toe results in little or no disability, according to a study published in Clinical Orthopaedics and Related Research and conducted by Roger Mann, past president of the American Orthopaedic Foot and Ankle Society. Mann observed a slight thickening of the skin on the second and third toes of the impaired foot, and the patients wore down their shoes on that side more. ...

SOURCE:
Fact or Fiction?: No Big Toe, No Go
Scientific American

https://www.scientificamerican.com/article/no-big-toe-no-go/
 
his thumb could be replaced (by his toe) using a rare procedure called "toe-to-thumb reconstruction."

I suppose interdigital transphalanxoplasty just never made it past the focus-group selection stage....
 
My mother lost a big toe, and once healed up, she walked just fine.

She was worried, but Grandad told her about Cricketeers who had lost them all and still played!

Missing a thumb is a serious disability; a big toe is an inconvenience. I have no idea where this myth came from.

Or why there hasnt been more interdigital transphalanxoplastys been done.
 
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