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.
