Second toe-to-thumb transfer for reconstruction of a mutilated hand following firecracker blast injury – a case report

Abstract

Firecracker blast injuries to the hand often result in severe mutilation with loss of the thumb, significantly impairing hand function. Restoration of thumb is critical for opposition and prehension. A 30-year-old right-hand dominant male presented with a mutilated right hand following a firecracker blast injury, with amputation of the thumb at the metacarpophalangeal joint, index finger amputation, and middle finger loss at the carpometacarpal level. Initial management included emergency debridement, skeletal stabilization, and soft tissue coverage using a groin flap. First web space deepening was performed at 6 months. Definitive reconstruction with a left second toe-to-thumb transfer was carried out one year after injury using a two-team approach. The postoperative course was uneventful with complete flap survival. At 1-year follow-up, the patient achieved functional opposition and was able to perform activities such as writing, holding objects, and riding a bike. Second toe transfer is a reliable option for thumb reconstruction in mutilated hands, even in delayed settings. A staged approach facilitates optimal functional outcomes.