FIG. 3-20

CASE 5

This patient lost all fingers and all but the proximal half of the proximal phalanx of the thumb.

FIG. 3-21. Extent of injuries.

FIG. 3-22. An ulnar opposable digit was planned with a second toe and metatarsal transplant. The thumb metacarpal was transected and prepared for elongation with a distraction apparatus.

FIG. 3-23. Rapid distraction was achieved and the gap in the metacarpal grafted with a banked portion of the second toe metatarsal.

CASE 6

The index finger was reconstructed in this patient.

FIG. 3-24. Index finger reconstruction. A fixed flexion contracture is present at the DIP and PIP joints. The patient has minimal sensation and marked cold intolerance.

FIG. 3-25. In lieu of ray amputation, which the patient did not wish, the second toe was mobilized.

FIG. 3-26. The ischemic atrophic distal two phalanges of the index were discarded and all structures replaced with the second toe.

FIG. 3-27. Chuck pinch and sensate pulp-to-pulp pinch have been restored. The patient is a contractor and uses the new index finger in his dominant left hand.

CASE 7

In this case, the distal phalanx of the index was crushed off.

FIG. 3-28. The injury left a painful amputation stump and a useless digit, kept in extension and vulnerable to further injury.

FIG. 3-29. The normal tactile pulp has been restored, giving the digital nerves a place to grow into.

FIG. 3-30. The patient, an accountant, uses his restored fingertip to operate his equipment.

CASE 8

This case is another example of a painful scarred index finger amputation.

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