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 FIG.
3-09. Length and pulp-to-pulp sensate pinch have been restored. The
digital nerves no longer end in painful amputation neuromas.
 FIG.
3-10. The defect in the foot produces no functional loss.
CASE 3
In this instance, the patient refused a great-toe transplant, which would have been aesthetically more acceptable.
 FIG.
3-11. Another example of loss of the thumb through the proximal portion
of the proximal phalanx.
 FIG.
3-12. The rather slender second toe is in place. The small size is
exaggerated by the wide diameter of the remaining proximal phalanx.
FIG 3-13. Good pulp-to-pulp pinch has been restored with the second-toe transplant; however, this photograph illustrates one of the drawbacks of the second-toe transplant - a flexion contracture at the proximal interphalangeal (PIP) joint. For this reason, the toe should be pinned in extension until tendons are well healed.
CASE 4
This patient lost all fingers except the thumb at the distal metacarpal level in a printing press.
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 FIG.
3-14. Extent of injury.
 FIG.
3-15. The patient has normal, powerful, full flexion and extension
of the thumb and use of his thenar muscles, but lacks an ulnar digit to
oppose or pinch.
 FIG.
3-16. The entire second toe and the second metatarsal shaft plus a
large skin flap have been removed as a unit to provide a digit on the
ulnar side of the hand for adequate length. Closure of the foot is simplified
by removing the entire second ray from the foot.
 FIG.
3-17. The second toe with the metatarsal joint has successfully built
up the ulnar side of the hand, providing a wide area for grasp.
 FIG.
3-18. The elongated ulnar digit now opposes to the tip of the thumb,
restoring tactile sensation and pinch or grip to an otherwise totally
crippled hand. The patient returned to his trade as a printer and continues
to be an avid sportsman. Three months after his injury, he carried a 150-lb
deer several miles without a problem.
 FIG.
3-19. The patient has developed strong tubular grip.
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