Microsurgical techniques have become useful in reconstructive surgeryn of the hand. Toe-to-hand transplantation is currently the procedure of choice for thumb loss reconstruction, as well traumatical as congenital. For a successful outcome meticulous planning is imperative and presumes a thorough knowledge of pertinent anatomy and surgical technique

The method of thumb reconstruction must be individualized and is dependent on the patient’s functional needs, age, and the level of the amputation. Postoperatvely, diligent nursing care is essential in assuring a positive outcome.

From Nov. 1979 to Dec. 2001 53 second toe-to-hand transfers were performed at Center of Replantation of Limbs in Trzebnica/Poland. Mean age was 27 years. Males (79%) and manual workers (91%) dominated the series

The rate of failure was 5,5%. The transfer gave functionally acceptable thumb with 8–12 mm two poin discrimination, on average 55% of strength in pinching (compared with unaffected side), 35 degrees of range flexion (but with flexion contracture)and poor cosmesis. Second toe transfers are preferable in cases with proximal thumb amputations, and in children. Their main advantage is the minimal morbidity of the donor site.