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Old 03-03-2006, 12:16 PM   #1
Wozzer
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Reattaching Severed Toes

Another thread here involves a debate on which boots to wear and many stated that toes are "easily reattached" if severed (particularly in reference to the use of steel toe boots). I wanted to provide some facts on toe replantation (reattachment of a severed toe) in a thread that anyone could easily search for - I think it has relevance outside of just choosing which boots to wear in that other thread. My sources are all published papers in medical journals (references included).

First off, I couldn't find a lot of papers on toe replantation. This isn't just me being inept, as one paper states "Traumatic amputation of the big toe is uncommon and only a few articles have been published on its replantation." Big-toe replantation in a three-month-old child: case report. J Reconstr Microsurg. 2004 Jul;20(5):373-5. There don't seem to be any big studies of it, just small studies and mostly case studies (reports of a single patient). "Although successful replantations involving digits, hands, and upper and lower extremities have become fairly routine, replantations of big toe amputations have been extremely sparse and only a few article have been published."

In general, whether or not your toe would even be eligible for replantation isn't really known. There are no clear-cut indicators of sucess for this surgery (prev paper states age, socialcultural status, type of injury and the patient's expectations/demand, and "Patient demand and expectation are the most important criterian in making a decision for big-toe replantation"), you and your doctor have to more or less "guess" at whether it will work or not. If you suffer a great toe (big toe) amputation then you will probably get a replantation attempted, for other toes it depends on your age and whether you want it.

As to how sucessful the proceedure is, in Should the amputations of the great toe be replanted? (Ademoglu et al., Foot and Ankle International Volume 21, Issue 8 , 2000, Pages 673-679) "Seventeen great toes, amputated at the distal phalangeal to the level of the MTP joint, were replanted between 1990 and 1998, at Izmir Hand and Microsurgery Hospital. Replantation in five out of six complete amputations, and seven out of eleven incomplete amputations were successful, and the overall survival rate was 76.4%." So while the odds aren't horrendeous, they're not great either.

The one good thing is that for patients who had sucessful surgery, they "had no significant subjective symptoms, nearly normal ROM [range of motion] of the MTP joint and protective sensation was achieved in the replanted great toes."

Now another point is that replantation of digits requires a SKILLED plastic surgeon who can sucessfully anasthamose (reconnect) all the tiny blood vessels and nerves that have been severed. You're only going to find such surgeons at major academic medical centers in the bigger cities. If you're going to a rural hospital it's unlikely anyone will have the training to attempt such a proceedure.

Hope that helps.
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Old 03-03-2006, 12:27 PM   #2
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Re: Reattaching Severed Toes

Good information, thanks for your research.
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Old 03-03-2006, 01:14 PM   #3
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Re: Reattaching Severed Toes

Don't ask how I know this, but it must be a VERY clean cut for reattachment to be possible.
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Old 03-03-2006, 01:19 PM   #4
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Re: Reattaching Severed Toes

I have 2 severed and reattached fingers on my left hand from a radial arm saw accident (with a dado blade)
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Old 03-03-2006, 01:24 PM   #5
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Re: Reattaching Severed Toes

i'm tempted to conclude that toe amputation is so rare that it really isn't a good reason to buy boots. *crushed and road-rashed ankles are probably the really important things to consider when buying boots.
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Old 03-03-2006, 01:27 PM   #6
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Re: Reattaching Severed Toes

Quote:
Originally Posted by ridesideways
i'm tempted to conclude that toe amputation is so rare that it really isn't a good reason to buy boots. *crushed and road-rashed ankles are probably the really important things to consider when buying boots.
I wouldnt say crushed or road-rashed is still really the reason.............. I say the real reason is to keep your foot pointing in the proper direction.... meaning, I would really hate to have a get-off, and try to stand up , and find my foot is pointed south, when I am trying to go north..... if you get my drift....
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Old 03-03-2006, 01:35 PM   #7
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Re: Reattaching Severed Toes

Quote:
Originally Posted by ridesideways
i'm tempted to conclude that toe amputation is so rare that it really isn't a good reason to buy boots. crushed and road-rashed ankles are probably the really important things to consider when buying boots.
That's entirely possible - we also should consider that the lack of papers on it could be due to many other factors though: 1) Low patient demand - many patients may not be willing to go through the emotional and physical trial of major surgery and also pay thousands and thousands of dollars to reattach a toe, I don't think toe amputation affects quality of life as much as say fingers 2) Low research focus - there aren't that many plastic surgeons around and since finger amputation is probably considered a greater priority, more plastics folks probably want to focus their research elsewhere. I have no idea what the actual reasons are, sorry.

That reminds me - my friend lowsided in sneakers and received a mean looking laceration from his ankle upwards and was on crutches for a couple weeks. Seeing that was enough to convince me that boots were a good idea.
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Old 03-03-2006, 05:10 PM   #8
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Re: Reattaching Severed Toes

Anyone ever see the ripleys believe it or not where they cut off the guys big toes and made thumbs out of them.
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Old 03-03-2006, 05:24 PM   #9
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Re: Reattaching Severed Toes

Quote:
Originally Posted by drbuff123
Anyone ever see the ripleys believe it or not where they cut off the guys big toes and made thumbs out of them.
Toe to digit transfers are actually not that much of an uncommon proceedure, they're done after the inital injury is healed up.
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Old 03-04-2006, 11:48 AM   #10
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Re: Reattaching Severed Toes

Quote:
Originally Posted by drbuff123
Anyone ever see the ripleys believe it or not where they cut off the guys big toes and made thumbs out of them.
Is that for real?


Your big toe is an extremely important part of your ability to balance yourself and move effectively. I'd say your thumb is more important, but it's a tremendous loss to lose a big toe. It's also a tremendous risk to take that the surgery may not work and you'll lose both.
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