Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 2:
Neurovascular Island and Heterotopic Transplantation
  FIG. 2-05. The sensory island flap has been used to resurface the entire volar tactile surface of the thumb, anastomosing the digital nerve from the lateral side of the toe to the digital nerves of the thumb and reestablishing normal cortical orientation to the sensory pinch area of the thumb.

FIG. 2-06. Normal cortical orientation to the sensory pinch area of the thumb has been re-established.

FIG. 2-07. Good, solid pulp-to-pulp pinch of normal consistency has been re-established by replacing the floppy, insensate abdominal skin with the island flap from the toe.


An avulsive injury of the entire distal phalanx of the thumb was resurfaced circumferentially with a groin flap.

FIG. 2-08. The groin flap is floppy, insensate, and unaesthetic.

FIG. 2-09. The large island flap from the lateral aspect of the great toe extends from the midline to the nail margin and is mobilized on a dorsal venous pedicle. The plantar nerve innervates the island.

FIG. 2-10. The entire volar tactile area of the thumb has been replaced with the physiologically similar tissue from the toe.



In this case, there was partial amputation of the pulp substance of the distal radial aspect of the thumb, with marked deformity of the nail and loss of most of the nailbed.

FIG. 2-11. In this instance, the neurovascular island flap not only carries the normal pulp substance of the great toe but the entire nail plate of the great toe, plus a shaving of bone from the distal phalanx, similar to a "wraparound. "

FIG. 2-12. The neurovascular island flap is totally isolated on the dorsal vein, the volar artery, and nerve, plus the entire nail plate and bed.

FIG. 2-13. The entire nail and half of the distal pulp of the thumb have been replaced with the island flap from the toe, anastomosing the lateral digital nerve of the toe to the radial digital nerve to the thumb.

FIG. 2-14. Dorsal view of the digit, which is somewhat larger than the normal thumb.


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