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[Problems in the surgical technic used in free toe transfer].

Based on the experiences of sixteen toe-to-hand transfers (nine for thumb reconstruction, seven for finger replacement), some technical problems of the operation are discussed. On the foot the incision should be planned in such a way that the wound can be closed directly to achieve a better aesthetic result The excision of the distal third of the second metatarsal bone marrows the foot, which improves the later appearance. On the hand deeper skin defects with exposed bone are easily closed by a forearm-island flap based on the distal radial artery. The rotation of the head of the transferred metatarsal into hyperextension gives the MP-joint much more excursion in flexion. If the great toe is used for thumb reconstruction and a new basal joint is necessary, this can be reconstructed with the dorsal half of the head of the first metatarsal, while its plantar half remains in the foot for weight bearing. The mobility of the new thumb was excellent following this procedure.