Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 2:
Neurovascular Island and Heterotopic Transplantation
  The multistage transfer of a finger of one hand to the other on an intact vascular pedicle was first described by Edgerton. 13 Others have transplanted fingers on an undamaged hand to a damaged hand. There have also been instances in which a thumb from a hand previously paralyzed has been transplanted to replace a recently amputated thumb on the uninjured side. Entire hands have also been transferred by classical techniques from a paralyzed hand to restore a recently amputated hand on the uninjured side. 14 This concept of using "spare parts" popularized by Chase and others" is well founded and the following case illustrates use of this principle to rehabilitate a hand by using an index amputation stump from one hand to lengthen the thumb on the opposite, extensively injured hand.

Pollicization of a left index stump to a right-thumb amputation stump was performed on a pilot who sustained frostbite of both hands after an accident in the Arctic. He lost all fingers and the thumb on the dominant right hand through the base of the proximal phalanx and the metacarpal Joint of the thumb. On the left hand, he lost the middle and distal phalanges of the index finger. In order to increase the ability to pinch and grasp, the shortened right thumb was extended by immediate pollicization of the residual proximal phalanx of the left index as a microvascular transplant.



A 42-year-old right-handed saw operator sustained a zone II amputation of the left index finger, together with destruction of a segment of the thumb including the IP joint, radial neurovascular bundle, and extensor tendon.

FIG. 2-21. Extent of injuries.

FIG. 2-22. Reconstruction was accomplished with heterotopic replantation of a composite segment of the index finger. The IP joint of the thumb was fused, and the radial digital artery and nerve and a dorsal vein of the donor index finger tissue were anastomosed to the radial digital artery and nerve and dorsal vein of the thumb both proximally and distally as an interposition segment of the index phalanx functioning as a vascularized bone flap. The extensor tendon was also repaired. A ray resection of the index finger stump completed the reconstruction.

FIG. 2-23. This reconstruction salvaged thumb function, providing the patient with useful power grasp.

FIG. 2-24. Opposition and pulp-to-pulp pinch were restored.


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