PRS Journal Club “Toe Transfers Outperform Replantation” with James Higgins, MD - Aug. 2025 Journal Club
Aug 6, 2025
In this engaging discussion, Dr. James Higgins, Chief of The Curtis National Hand Center, shares his pioneering insights in upper extremity microsurgery. He emphasizes the advantages of toe transfers over traditional digital replantation, revealing findings from a study that highlights better functional outcomes. The conversation also tackles patient counseling for reconstruction options, stressing the importance of informed consent and emotional support. With a wealth of experience, Dr. Higgins guides listeners through the complexities of surgical decision-making.
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Toe Transfers Show Better Long-Term Function
- Changgong's series found higher MHQ and SF-36 scores for toe transfers versus replants.
- Differences were significant for multiple-digit injuries.
Large Exclusions Create Follow-Up Bias
- James Higgins flags massive exclusions and follow-up bias in the cohort.
- Only a small fraction of toe transfers were included, which may skew outcomes.
Tripod Pinch Is A Key Predictor
- Achieving tripod pinch strongly predicts higher functional outcomes after toe transfer.
- Wei and Higgins emphasize radial toe positioning to restore tripod pinch in metacarpal hands.