Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 1:
Great Toe Transplantation
  FIG. 1-72. The great toe has been transplanted to the base of the metacarpal bone in a hyperextended position to increase the space between the toe transplant and the remaining phalangeal stumps.

FIG. 1-73. Dorsal view showing the durable groin flap cover and the potential pinch between the transplanted thumb and the metacarpal stumps.

FIG. 1-74. Strong pinch has been provided between the transplanted toe and the remaining portion of the hand.

FIG. 1-75. The importance of the single transplant is well illustrated in this case, in whichkey pinch between the thumband metacarpal stumpshas permitted the patient to have tactile contact with his environment. He is able to write again with his dominant hand.

FIG. 1-76. The patient's ability to grasp objects with his sensate right hand and the prosthesis on his left elbow amputation have permitted him to become independent and self-supporting.


A 23-year-old woman suffered a partial amputation from an aircraft propeller of her right arm and multiple digits.


FIG. 1-77. Extent of the injuries.

FIG. 1-78. The revascularized fingers have become necrotic.

FIG. 1-79. Condition of the hand after necrotectomy is shown.

FIG. 1-80. A toe-to-hand transplantation has been performed.

FIG. 1-81. Late follow-up shows donor site and good function.

FIG. 1-82. Final result.


Restoration of good appearance and function is the ultimate goal in any reconstructive effort. The preceding cases have demonstrated these principles. The following illustrations summarize these goals.

FIG. 1-83. The thumb in arboreal primates is not as developed as the great toe because the latter is used to hold on to branches. In man, the reverse is true.

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