Risk factors for reexploration in toe-to-hand transfer: A multivariate analysis of 363 cases

Background: Reexploration after toe-to-hand transfer increases the risk of failure. In this study, the authors aimed to identify risk factors for reexploration after toe-to-hand transfer. Methods: The medical records of 363 patients who underwent single toe-tohand transfer between 2000 and 2010 were reviewed retrospectively. Patient demographics, clinical data, and operative data were collected, and multivariate analysis was performed. Results: Of these 363 patients, 299 toes (82.4 percent) had primary success in transplantation. Sixty-four toes required reexploration, of which seven toes failed. The overall success rate was 98.1 percent. Of the 64 toes that required reexploration, arterial spasm was found in 39 (60.9 percent), arterial thrombosis was found in 27 (42.2 percent), and venous thrombosis was found in 16 (25.0 percent). Multivariate logistic regression analysis revealed that postoperative wound infection, metacarpal hand injuries, and preceding flap coverage were independently associated with reexploration. Conclusions: Reducing reexploration in toe-to-hand transfer may be facilitated by managing or avoiding these risk factors. Particular attention must be paid to avoid postoperative wound infection, which was the single greatest factor contributing to reexploration (adjusted OR, 12.6).