Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 2:
Neurovascular Island and Heterotopic Transplantation
  A 22-year-old carpenter sustained a saw amputation of the tip of his dominant right thumb and a zone II injury of his right index finger.

FIG. 2-25. Extent of injuries.

FIG. 2-26. The amputated thumb fragment was too badly damaged to be replanted.

FIG.2-27. The amputated index finger fragment was intact, but replantation of the index finger was likely to result in poor function and therefore was not undertaken.

FIG. 2-28. The distal fragment served as an innervated osteocutaneous neurovascular free flap (including a nail) to reconstruct the thumb.

FIG. 2-29. The index finger tip was transplanted to the stump of the thumb.

FIG. 2-30. Wide span is provided by the second ray amputation.

FIG. 2-31. Full flexion.

FIG. 2-32. Useful opposition.


A 42-year-old cabinet maker suffered concomitant saw amputations of his right thumb and index finger and partial amputations of his long and ring fingers.


FIG. 2-33. Extent of injuries.

FIG. 2-34. The index was relatively clean, but the thumb volar tissues were destroyed.

FIG. 2-35. X ray of amputated parts.

FIG. 2-36. X ray of proximal stumps. Other digits have been pinned.

FIG. 2-37. A ray amputation of the index finger completed the reconstruction, providing wide grip.

FIG. 2-38. Fundamental pinch is also provided.


A 36-year-old carpenter sustained an ipsilateral, multilevel, multidigit and wrist-level hand amputation.

FIG. 2-39. Dorsal view of amputated hand.

FIG. 2-40. The distal phalanx and volar tissues of the right thumb were gone. The amputated middle finger was fairly undamaged.

FIG. 2-41. The proximal wrist was prepared to receive the amputated hand.

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