FIG. 3-93

FIG. 3-94. The referring hand surgeon counseled the patient on the advisability of immediate reconstruction to preserve the proximal phalangeal stumps and metacarpophalangeal joints (shown in x ray). Wound closure would have required bone shortening or a pedicled flap.

FIG. 3-95. The second toe from each foot was disarticulated through the MT joint.

FIG. 3-96. Each toe was transplanted to the hand in sequence.

FIG. 3-97. Excellent metacarpophalangeal joint function was restored to the ulnar two digits. Extension is shown.

FIG. 3-98. Flexion is shown.

FIG. 3-99. Large tubular grasp was restored.

FIG. 3-100. Delicate sensate pulp-to-pulp pinch was also restored.

Great-Toe and Second-Toe Transplants

Occasionally, the great toe from one foot and the second toe from the opposite foot can be used to replace the loss of the thumb and multiple digits.

CASE 19

This case involved a totally functionless hand, but one with great potential. From Buncke, H.J., Valauri, F.R., and Buncke, G,M.: Toe to Hand. In Textbook of Microsurgery. Edited by Brunelli G. Milano, Nason, 1988, pp. 305-318.

FIG. 3-101. Part of the proximal phalanx of the thumb remains. This is an ideal situation for a great-toe transplant. Unfortunately, the metacarpophalangeal joints are missing on the ulnar part of the hand, but the metacarpal shafts are present.

FIG. 3-102. Clay models of the great toe from the left foot and the second toe from the right foot are in place. The entire second metatarsal joint and shaft will be transplanted with the second-toe transplant to give additional length and joint motion on the ulnar side of the hand.

FIG. 3-103. Potential two-point pulp pinch is demonstrated on the model transplants.

FIG. 3-104. The proximal phalanx of the toe was hollowed to fit over the remnant thumb proximal phalanx.

FIG. 3-105. Palmar view shows wide space between digits.

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