FIG. 2-42

FIG. 2-43. The middle finger was tailored to replace the thumb tissue.

FIG. 2-44. Late follow-up.A. Extension. B. Flexion. C. Useful pinch. D. Useful grip.

CASE 9

A 52-year-old carpenter sustained a power saw injury to the left thumb and index finger.

FIG. 2-45. Complete amputation of the index at the metacarpal joint and segmental loss of the dorsal soft tissue and two-thirds of the proximal phalanx and DIP joint of the thumb.

FIG. 2-46. The index finger proximal phalanx and a large skin island were fashioned into an osteocutaneous microvascular flap. The interpositional bone graft was stabilized with an intraosseous pin.

FIG. 2-47. X ray shows osteocutaneous neurovascular transplant in place.

FIG. 2-48. Veins, nerves, and digital arteries of the flap were anastomosed in a segmental fashion to similar disrupted structures in the thumb, proximally and distally revascularizing and re-establishing nerve continuity.

FIG. 2-49. The extension mechanism was repaired in a similar fashion. The revascularized compound index-thumb digit functions well.

CASE 10

This patient had a lawnmower injury of the hand. (From Alpert, B.S., and Buncke, H.J.: Mutilating multidigital injuries: Use of free microvascular flap from a nonreplantable part. J. Hand Surg. 3:196, 1978.)

FIG. 2-50. Amputation of the little and ring fingers and multiple comminuted fractures of the long finger and similar injury to the index finger, with a triangular defect of soft-tissue neurovascular bundle down to the underlying comminuted fracture of the middle phalanx. A cross-finger flap cannot he fashioned because of the injury to the adjacent long finger.

FIG.2-51. The amputated ring finger with multiple levels of injury. This is a nonreplantable part; however, a small neurovascular island flap was taken from this non-replantable digit and used as a microvascular free transplant.

FIG. 2-52. The small neurovascular transplant on the end of the tongue blade illustrates the true microsurgical nature of this procedure.

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