FIG. 3-58. This child had bilateral anomalies; however, the middle finger of her right hand was the only digit that she wanted reconstructed.

FIG. 3-59. Deformities were also present in the lateral two toes of each foot. The second toe was disarticulated through the MT joint.

FIG. 3-60. Recipient structures were all found in the hand.

FIG. 3-61. The remnant of the proximal phalanx of the finger was used as an intramedullary peg into the proximal phalanx of the toe.

FIG. 3-62. The reconstructed long finger now adds dexterity to the hand and improves appearance.

FIG. 3-63. Grasp has been improved. The patient plays piano and is an expert typist.

CASE 13

This child had multiple digital deformities.

FIG. 3-64. The fusiform ring finger of the left hand was prepared to receive a transplant of the middle and distal phalanxes of the second toe.

FIG. 3-65. The remainder of the toes were congenitally short.

FIG. 3-66. The reconstructed digit appears more normal than the remaining ones.

Double Toe Transplants

Injuries involving the loss of multiple digits from one or both hands are not unusual. 8-11 As noted previously and also in the chapter on multiple microvascular transplants, two to four toes can be used to reconstruct missing digits. With complex injuries, the transplanted toes are often the most functional digits in the injured hand.

CASE 14

A young woman sustained a crushing injury to the left index, long, and ring fingers.

FIG. 3-67. The foreshortened index and ring fingers caused the patient great concern and compromised hand function.

FIG. 3-68. The second toes from each foot were mobilized.

FIG. 3-69. Fortunately, the common volar arteries were uninjured, permitting anastomosis of the toe metatarsal vessels to the second and fourth metacarpal vessels.

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