Toe-to-hand transplantation for thumb and finger reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHENG Xianyou

Department of Orthopedics, the Sixth People’s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, 200233, P. R. China;

Corresponding?author：

ZHENG Xianyou, Email: zhengxianyou@126.com

Keywords：

Toe-to-hand transplantation; thumbs or fingers reconstruction; microsurgery

DOI：

10.7507/1002-1892.202511073

Video：

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Reconstruction of missing thumbs or fingers remains one of the most demanding challenges in hand surgery. Over the past century, toe-to-hand transplantation has evolved from early experimental pedicled transfers into a highly refined microsurgical procedure, now widely regarded as the “gold standard” for restoring hand function. This article reviews the historical and technical development of toe transplantation—from Nicoladoni’s pioneering concepts in the late 19th century, through Dr. Yang Dongyue’s landmark second-toe transfer performed in 1966, to contemporary Chinese contributions such as the “total-shape reconstruction” paradigm. Modern surgical practice incorporates individualized strategies and advanced techniques, including Dr. Gu Yudong’s supplemental vascular-supply design and Dr. Cheng Guoliang’s dual-pedicle bridging method, which collectively enhance functional recovery, aesthetic outcomes, and reliability. Emerging innovations such as three-dimensional-printed osseous scaffolds, artificial intelligence-assisted surgical planning, and tolerance-oriented transplant engineering are further driving the field toward greater precision, reduced morbidity, and improved long-term results.

1.	王濤, 顧玉東. 足趾移植重建拇、手指的歷史與現狀. 中華手外科雜志, 2021, 37(3): 215-218.
2.	Buncke GM, Buncke HJ, Lee CK. Great toe-to-thumb microvascular transplantation after traumatic amputation. Hand Clin, 2007, 23(1): 105-115.
3.	楊東岳, 顧玉東, 吳敏明, 等. 第二趾游離移植再造拇指40例報告. 中華外科雜志, 1977, 15(1): 13-18.
4.	顧玉東. 第二趾移植再造拇指的歷史回顧與展望. 中華手外科雜志, 2006, 22(1): 3-5.
5.	Gilbert A. Composite tissue transfer from the foot: anatomic basis and surgical technique//Daniller A, Strauch B. Symposium on Micro-surgery. St. Louis : Mosby, 1976: 230-241.
6.	Morrison WA, O’Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg (Am), 1980, 5(6): 575-583.
7.	Yu ZJ, He HG. Thumb reconstruction with free big toe skin-nail flap and bones, joints, and tendons of the second toe--report of the cases. Chin Med J (Engl), 1985, 98(12): 863-867.
8.	于仲嘉, 何鶴皋, 湯成華. 再造手. 中華醫學雜志, 1983, 63(11): 673-675.
9.	于仲嘉, 睦述平. 雙足第二、三足趾移植再造四指. 中華顯微外科雜志, 1993, 16(1): 29-31.
10.	Foucher G, Merle M, Maneaud M, et al. Microsurgical free partial toe transfer in hand reconstruction: a report of 12 cases. Plast Reconstr Surg, 1980, 65(5): 616-627.
11.	程國良, 方光榮, 侯書健, 等. 拇手指部分缺損的修飾性修復與重建. 中華醫學雜志, 2005, 38(85): 2667-2673.
12.	王增濤. 手指全形再造的重要意義. 中華顯微外科雜志, 2011, 34(4): 265.
13.	王增濤. 拇指及手指的全形再造. 中華顯微外科雜志, 2020, 43(5): 424-434.
14.	于仲嘉, 王琰. 手缺損再造一例. 中華醫學雜志, 1979, 59(10): 593-595.
15.	程國良. 不同形式的足趾移植拇手指再造與修復. 中華顯微外科雜志, 2002, 25(1): 8-9.
16.	袁光海, 程國良, 方光榮, 等. 半趾甲瓣移植修復手指末節半側缺損. 中華顯微外科雜志, 2002, 25(3): 168-169.
17.	顧玉東, 吳敏明, 鄭憶柳, 等. 足趾移植術中血管的變異及其處理. 中華外科雜志, 1985, 23(4): 210-212.
18.	程國良, 方光榮, 侯書健. 雙足第二趾節段橋接移植再造手指一例. 中華手外科雜志, 1999, 15(2): 71-72.
19.	張敬良, 任志勇, 王成琪. 第二足趾聯合腓側條形島狀皮瓣鑲嵌再造拇 (手) 指. 中華顯微外科雜志, 2001, 24(4): 252-253.
20.	韓西城, 吳昌其, 張正之, 等. 關于急診足趾游離移植再造拇指的探討. 山西醫學院學報, 1981(2): 36-37.
21.	壽奎水, 張全榮, 李向榮, 等. 亞急診修復和再造拇、手指358例報告. 中華手外科雜志, 1995, 11(4): 204-206.
22.	潘勇衛, 田文, 田光磊, 等. 改良游離踇甲皮瓣移植再造拇指. 中華手外科雜志, 2005, 21(2): 79-82.
23.	樊川, 袁海平, 王紅勝, 等. 微型坶甲瓣在拇指甲床重度缺損中的應用. 實用手外科雜志, 2015, 29(4): 409-411.
24.	黃一雄, 侯明鐘, 賈萬新, 等. 應用凍干異體手指骨關節肌腱腱鞘復合組織再造拇指. 中國矯形外科雜志, 2003, 11(8): 527-529.
25.	隋海明, 李金晟. 全手皮膚脫套傷早期顯微外科修復方法的選擇. 中華顯微外科雜志, 2000, 23(1): 32-34.
26.	程國良. 我國足趾移植拇手指再造與修復回顧與展望. 中華手外科雜志, 2007, 23(2): 65-68.
27.	劉亞平, 程國良, 孫樂天, 等. 第三趾脛側趾動脈皮瓣聯合第二足趾移植改善再造手指外形. 中華手外科雜志, 2010, 26(2): 95-97.
28.	袁光海, 程國良, 方光榮, 等. 半趾甲瓣移植修復手指末節半側缺損. 中華顯微外科雜志, 2002, 25(3): 168-169.
29.	Wu H, Hu Y, Wang Z, et al. Free vascularized fibula leads to hallux toe flexion deformity due to ischemic muscle contracture of flexor hallucis longus. Head Neck, 2024, 46(6): 1390-1399.
30.	Cardenas JM, Gordon D, Waddell BS, et al. Does artificial intelligence outperform humans using fluoroscopic-assisted computer navigation for total hip arthroplasty? Arthroplast Today, 2024, 27: 101410. DOI: 10.1016/j.artd.2024.101410.
31.	Wan S, Aregueta Robles U, Poole-Warren L, et al. Advances in 3D tissue models for neural engineering: self-assembled versus engineered tissue models. Biomater Sci, 2024, 12(14): 3522-3549.
32.	侯明鐘, 黃碩麟, 袁啟智, 等. 冷凍異體手指復合組織移植再造拇指200指. 中華手外科雜志, 1995, 11(4): 207-210.

1. 王濤, 顧玉東. 足趾移植重建拇、手指的歷史與現狀. 中華手外科雜志, 2021, 37(3): 215-218.
2. Buncke GM, Buncke HJ, Lee CK. Great toe-to-thumb microvascular transplantation after traumatic amputation. Hand Clin, 2007, 23(1): 105-115.
3. 楊東岳, 顧玉東, 吳敏明, 等. 第二趾游離移植再造拇指40例報告. 中華外科雜志, 1977, 15(1): 13-18.
4. 顧玉東. 第二趾移植再造拇指的歷史回顧與展望. 中華手外科雜志, 2006, 22(1): 3-5.
5. Gilbert A. Composite tissue transfer from the foot: anatomic basis and surgical technique//Daniller A, Strauch B. Symposium on Micro-surgery. St. Louis : Mosby, 1976: 230-241.
6. Morrison WA, O’Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg (Am), 1980, 5(6): 575-583.
7. Yu ZJ, He HG. Thumb reconstruction with free big toe skin-nail flap and bones, joints, and tendons of the second toe--report of the cases. Chin Med J (Engl), 1985, 98(12): 863-867.
8. 于仲嘉, 何鶴皋, 湯成華. 再造手. 中華醫學雜志, 1983, 63(11): 673-675.
9. 于仲嘉, 睦述平. 雙足第二、三足趾移植再造四指. 中華顯微外科雜志, 1993, 16(1): 29-31.
10. Foucher G, Merle M, Maneaud M, et al. Microsurgical free partial toe transfer in hand reconstruction: a report of 12 cases. Plast Reconstr Surg, 1980, 65(5): 616-627.
11. 程國良, 方光榮, 侯書健, 等. 拇手指部分缺損的修飾性修復與重建. 中華醫學雜志, 2005, 38(85): 2667-2673.
12. 王增濤. 手指全形再造的重要意義. 中華顯微外科雜志, 2011, 34(4): 265.
13. 王增濤. 拇指及手指的全形再造. 中華顯微外科雜志, 2020, 43(5): 424-434.
14. 于仲嘉, 王琰. 手缺損再造一例. 中華醫學雜志, 1979, 59(10): 593-595.
15. 程國良. 不同形式的足趾移植拇手指再造與修復. 中華顯微外科雜志, 2002, 25(1): 8-9.
16. 袁光海, 程國良, 方光榮, 等. 半趾甲瓣移植修復手指末節半側缺損. 中華顯微外科雜志, 2002, 25(3): 168-169.
17. 顧玉東, 吳敏明, 鄭憶柳, 等. 足趾移植術中血管的變異及其處理. 中華外科雜志, 1985, 23(4): 210-212.
18. 程國良, 方光榮, 侯書健. 雙足第二趾節段橋接移植再造手指一例. 中華手外科雜志, 1999, 15(2): 71-72.
19. 張敬良, 任志勇, 王成琪. 第二足趾聯合腓側條形島狀皮瓣鑲嵌再造拇 (手) 指. 中華顯微外科雜志, 2001, 24(4): 252-253.
20. 韓西城, 吳昌其, 張正之, 等. 關于急診足趾游離移植再造拇指的探討. 山西醫學院學報, 1981(2): 36-37.
21. 壽奎水, 張全榮, 李向榮, 等. 亞急診修復和再造拇、手指358例報告. 中華手外科雜志, 1995, 11(4): 204-206.
22. 潘勇衛, 田文, 田光磊, 等. 改良游離踇甲皮瓣移植再造拇指. 中華手外科雜志, 2005, 21(2): 79-82.
23. 樊川, 袁海平, 王紅勝, 等. 微型坶甲瓣在拇指甲床重度缺損中的應用. 實用手外科雜志, 2015, 29(4): 409-411.
24. 黃一雄, 侯明鐘, 賈萬新, 等. 應用凍干異體手指骨關節肌腱腱鞘復合組織再造拇指. 中國矯形外科雜志, 2003, 11(8): 527-529.
25. 隋海明, 李金晟. 全手皮膚脫套傷早期顯微外科修復方法的選擇. 中華顯微外科雜志, 2000, 23(1): 32-34.
26. 程國良. 我國足趾移植拇手指再造與修復回顧與展望. 中華手外科雜志, 2007, 23(2): 65-68.
27. 劉亞平, 程國良, 孫樂天, 等. 第三趾脛側趾動脈皮瓣聯合第二足趾移植改善再造手指外形. 中華手外科雜志, 2010, 26(2): 95-97.
28. 袁光海, 程國良, 方光榮, 等. 半趾甲瓣移植修復手指末節半側缺損. 中華顯微外科雜志, 2002, 25(3): 168-169.
29. Wu H, Hu Y, Wang Z, et al. Free vascularized fibula leads to hallux toe flexion deformity due to ischemic muscle contracture of flexor hallucis longus. Head Neck, 2024, 46(6): 1390-1399.
30. Cardenas JM, Gordon D, Waddell BS, et al. Does artificial intelligence outperform humans using fluoroscopic-assisted computer navigation for total hip arthroplasty? Arthroplast Today, 2024, 27: 101410. DOI: 10.1016/j.artd.2024.101410.
31. Wan S, Aregueta Robles U, Poole-Warren L, et al. Advances in 3D tissue models for neural engineering: self-assembled versus engineered tissue models. Biomater Sci, 2024, 12(14): 3522-3549.
32. 侯明鐘, 黃碩麟, 袁啟智, 等. 冷凍異體手指復合組織移植再造拇指200指. 中華手外科雜志, 1995, 11(4): 207-210.

Chinese Journal of Reparative and Reconstructive Surgery

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