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 FIG. 1-63. Lateral view showing the key type of pinch between the powerful toe transplant and the residual portion of the ulnar part of the hand. Second-toe transplant to the ring position would augment this grip considerably. The patient returned to the construction industry.
CASE 11
This patient had a one-fingered hand with loss of the thumb, index, long, and ring fingers, a hand with no pinch or grasp.
 FIG. 1-64. There is a remnant of the articular surface of the first metacarpal, so that a reconstruction of the metacarpophalangeal joint at the base of the thumb can be planned.
 FIG. 1-65. An x ray of the metacarpal bone shows a healed fracture through its base.
 FIG. 1-66. The great toe has been transplanted, preserving the articular surface at the base of the proximal phalanx, which now articulates with the remnant of metacarpal cartilage.
 FIG. 1-67. The transplant has good opposition, with good flexion at both the metacarpophalangeal joint and the distal joint of the thumb.
 FIG. 1-68. Good pulp-to-pulp pinch between the tip of the thumb and the only remaining finger.
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 FIG. 1-69. The ability to grasp large objects has been restored.
 FIG. 1-70. The ability to grasp small objects has also been restored. The patient has a strong key type of pinch between the thumb and the radial side of the remnant proximal phalanx of the index, which might have been compromised if a ray resection had been performed to deepen the first web space.
CASE 12
Great-toe transplant was performed to a severely mutilated hand left with only metacarpal stumps. (From Buncke, H.J., Alpert, B.S., and Valauri, F.A.: Follow-up toe to thumb transplantation. Plast. Surg. 2:185, 1988.)
 FIG. 1-71. A portion of the base of the first metacarpal bone is present, so that a foreshortened great-toe transplant can be fashioned to provide key pinch to the remaining proximal phalangeal stumps of the fingers, which are covered with a groin flap on the dorsal surface but scarred skin on the volar surface.
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