Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Epilogue
  The thumb was amputated after isolating comparable structures. The radial artery was carefully mobilised into the base of the thenar eminence, cleaned of adventitia, clamped with atraumatic clamps and transected. The cephalic vein was mobilised out into the first web space and clamped in a similar fashion. The extensor pollicis longus and flexor pollicis longus tendons were identified and cut long. The digital nerves to the thumb and motor branch of the thenar eminence were mobilised proximally into the wrist and split off the trunk of the median nerve and left long. At this point the tourniquet was released and obvious bleeders clamped and tied.

The amputated thumb was then discarded and the free hallux brought into position (Figs. 2 D, E, F and 3 B, C). Stability was provided by a stainless steel pin passed across the metatarsal navicular joint. The extensor hallucis longus was sutured to the extensor pollicis longus and the flexor hallucis longus was sutured to the flexor pollicis longus with a single double right angle suture of 4.0 nylon in each tendon. The vascular repairs were then undertaken utilising the Zeiss Diploscope for magnification and 10 micron monofilament nylon with a fusiform metalised needle tip for the suture material (Buncke and Schultz, 1965).


FIG. 5 A, Transplant No. 1 at two weeks, primary healing of all incisions, with minimal swelling. B, Transplant No. 1 at two months. C, Transplant No. 2 at two weeks. D, Transplant No. 2 at two months.

Fig. 6.-Transplant No. 3 at ten days - complete necrosis of hallux.

Fig. 7.-Photomicrograph of a longitudinal section through a patent vein anastomosis showing continuity of intima and minimal reaction about suture material.

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