Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 2:
Neurovascular Island and Heterotopic Transplantation
  This case involved restoration of pulp substance in the index finger. (From Buncke, H.J., and Rose, E.H.: Free toe-to-fingertip neurovascular flaps. Plast. Reconstr. Surg. 63:607 1979.)

FIG. 2-15. The entire pulp substance of the pinch area of the index finger has been lost after a snakebite injury.

FIG. 2-16. Lateral view of the digit shows the skin graft on the volar surface of the index. The digit is completely useless because of pain.

FIG. 2-17. In this instance, the entire pulp area of the second toe has been mobilized on the two volar nerves and the artery to the first web space, plus a large dorsal vein.

FIG. 2-18. The island flap is next to the recipient area on the index where proximal nerves, arteries, and veins have been mobilized.

FIG. 2-19. The entire pulp substance of the distal phalanx of the index finger has been restored with the island transplant from the second toe, restoring normal function to an otherwise useless index finger.

FIG. 2-20. Normal cortical feedback returns, a function seldom achieved with pedicled NVI flaps from other fingers.


Transplantation from Finger to Finger

As mentioned earlier, neurovascular island flaps have been transferred on intact pedicles to resurface critical pinch areas. An expansion of this concept is useful on both acute and elective situations to restore maximal function following multidigit amputation.

The replantation surgeon is often presented with a multidigit injury concomitantly involving the nonreplantable destruction of the thumb. Mindful of the critical role the thumb plays in hand function, a first priority is restoration of thumb function.

One strategy is to use an undamaged portion of an amputated digit as an immediate heterotopic replant to reconstruct the thumb where replantation of the amputated thumb itself is not possible. 7 Our results have been gratifying, and we have used this concept electively to improve hand function.

Hand-to-hand Digital Transplants

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