The complete or partial absence of one or more digits severely impairs the function of the affected hand. We present ours experience in hand reconstruction after uni- or pluridigital losses due to various traumas. Material and methods The lesions involve the thumb -single amputation or in association with other digits or one or more of the II - V digits. The transfers were performed in emergency (first 36 hours after trauma) or as delayed intervention in an interval of 2 weeks to two years in the others cases. In 4 cases we reconstruct more than one digital ray using consecutive or simultaneous double free digital transfer. In other cases the digital transfer was part of a complex microsurgical reconstruction including multiple free flaps transfer.

We used for thumb reconstruction the great –toe in 80% of cases and the second toe in 20% cases. The great toe was used as whole entity, trimmed, partially (distal phalanx or only the soft elements) or wraparound. The II to V digital rays were reconstructed using the second toe or a digital block of second and third toes. Results The transferred toes survived in 94% of cases. The sensitive recovery was very good in 70%cases and satisfactory in 30% cases. The range of mobility is variable from just few degrees and joint stiffness to 90 degrees of flexion in the new MP joint. The patients were able to return to work in 6 to 8 months, 55% of them at the same job.

Conclusions The digital flap is in our opinion the best method to reconstruct the hand with fingers losses. The great toe partially or trimmed represent our first option in thumb reconstruction. When more than one digital ray is missing the variant of a double simultaneous free digital transfer represent a faster and better method to achieve a more functional result.