Reconstruction of an Amputated Thumb by Great Toe Harvested from a Simultaneously Amputated Lower Limb: Spare Part Surgery Concept Revisited

Sep 28, 2026

The article presents a clinical case centered on “spare part surgery” in reconstructive microsurgery: using tissue from a required amputation site to restore function in another injured area. A patient with a nonsalvageable lower-limb crush injury and traumatic hand injury requiring thumb amputation underwent great-toe harvest before above-knee amputation. The reconstructed thumb was later used for daily activities, including wearing a lower-limb prosthesis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Abstract and Keywords

Introduction

Case Report

Injury and initial management

Decision for amputation and reconstruction

Surgical procedure: great-toe transfer

Follow-up and functional recovery

Article published online: 2025-08-06 468 Case Report THIEME Reconstruction of an Amputated Thumb by Great Toe Harvested from a Simultaneously Amputated Lower Limb: Spare Part Surgery Concept Revisited S. Raja Sabapathy 1 Hari Venkatramani 1 Madhu Periasamy 1 Aditya Narasimhan 1 Monusha Mohan 1 Vamseedharan Muthukumar 1 1 Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India Indian J Plast Surg 2025;58:468–471. Address for correspondence S. Raja Sabapathy, MS, MCh (Plastic), DNB (Plastic), FRCS (Edin), Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore 641043, Tamil Nadu, India (e-mail: [rajahand@gmail.com](rajahand@gmail.com)). Abstract Keywords ► toe transfer ► thumb reconstruction ► spare part surgery Utilization of tissues from the amputated part to cover critical structures or enhance function in another area is a valuable technique in reconstructive surgery. For this“spare part surgery” to occur high level of awareness is to be present among surgeons who perform the primary procedure. We are presenting a case wherein the great toe was harvested for thumb reconstruction in a patient who had a nonsalvageable lower limb injury with a crush injury of the hand with amputation of multipleﬁngers includingthe thumb. The patient on follow-up is using his reconstructed thumb for all his activities including for wearing the lower limb prosthesis. Harvesting the toe from the to be amputated part has the advantages of harvesting more skin, longer length of tendons, vessels, and nerves since there is no need for donor site closure or any concern for donor site morbidity. Introduction Loss of thumb results in functional loss amounting to 40% of hand function.1 Microvascular toe-to-hand transfer is the gold standard for reconstructing an amputated thumb, typically performed electively. Situations rarely occur where there is an amputation of the lower limb with the same patient requiring thumb reconstruction. We present a case where the great toe was harvested prior to above-knee amputation of a nonsalvageable lower limb and was used to reconstruct the thumb with successful rehabilitation. Increased awareness of the possibility is essential to seize the opportunity of thumb reconstruction sourcing the toe from the limb to be amputated. article published online August 6, 2025 DOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1810110 . ISSN 0970-0358. Case Report A59-year-old right-handed man sustained crush injuries to his right hand and left lower limb while attempting to board a moving train. He suffered a grade 3B open supracondylar fracture of the femur and a Schatzker type IV fracture of the tibia with skin loss extending from the middle of the thigh to the middle of the leg. Primary management at another center involved debridement and skeletal stabilization of the left lower limb fractures ( ►Fig. 1). The right hand suffered thumb amputation at the metacarpal head level, index ﬁnger through the neck of metacarpal, and the middle ﬁnger through proximal phalanx ( ►Fig. 2). He reached our hospital 10 days postinjury for soft tissue reconstruction of the lower limb. © 2025 . The Author(s) . This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited.([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)) Thieme Medical and Scientiﬁc Publishers Pvt. Ltd. , A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Reconstruction of an Amputated Thumb by Great Toe Sabapathy et al. 469 Fig. 1 Presenting images of the left lower limb. (A) Nonsalvageable limb with a Mangled Extremity Severity Score (MESS) of 7 and Ganga Hospital Open Injury Severity Score (GHOISS) of 14 .

FAQs

What functional outcome was reported after treatment?

With follow-up, the patient could use the reconstructed thumb for activities, including pinch and grasp tasks and using a lower-limb prosthesis.

Sep 28, 2026

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