PLATE III-4

A B C D E F . The reconstructed digit is shown in this diagram. One arterial anastomosis (from the plantar artery of the toe to the palmar artery of the finger) and one dorsal venous anastomosis were carried out. The digital nerves and the flexor and extensor tendons were repaired. The peg of the middle phalanx was placed in the medullary cavity of the proximal phalanx of the toe, and interosseous wires were used for fixation. The cosmetic result was satisfactory and the functional result was excellent, owing to the good range of motion of the proximal interphalangeal joint.

Clinical Cases

CASE 1

Thumb reconstruction was performed in a 5-year-old boy who lost his left thumb through the base of the proximal phalanx when it was crushed in a car door.

FIG. 3-01. The metacarpophalangeal joint was salvaged with a traditional tubed pedicle abdominal flap.

FIG. 3-02. The right second toe was isolated on the dominant superficial metatarsal artery (background) and a large vein. Eight cm of flexor tendon could be isolated without plantar counter-incisions.

FIG. 3-03

FIG. 3-04. The toe was anastomosed to the dorsal radial artery in the anatomic "snuffbox." The right foot was used to have the vascular pedicle line up with the dorsal radial artery.

FIG. 3-05. The growth plate in the residual proximal phalanx was preserved. The synostosis was purposely angulated dorsally to increase the first web space.

FIG. 3-06. Thumb length has been restored. Sensory return in children is often dramatic and approaches normal.

FIG. 3-07. Opposition, pulp-to-pulp pinch, and grasp have been recreated. The second toe seems to have hypertrophied in its new position on the hand. Such a phenomenon has been noted by Dr. James Keheler after pollicizing the little finger.

CASE 2

Thumb reconstruction is illustrated in this case.

FIG. 3-08. The distal phalanx has been lost and the amputation stump is painful and covered with unstable scar tissue.

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