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 FIG.
3-42. Transplantation of a second toe plus the metatarsal joint and
second metatarsal is planned.
 FIG.
3-43. All structures have been identified and dissected out of the
foot. The toe digital nerves are mobilized far proximally in the intermetatarsal
space.
 FIG.
3-44. Two-thirds of the metatarsal shaft have been carried with the
transplant.
 FIG.
3-45. Fortunately, recipient structures were found in the hypothenar
area.
 FIG. 3-46. X ray shows the base of the metatarsal in contact with the hamate.
 FIG. 3-47. A stable ulnar digit has been created with good motion at the metatarsal and interphalangeal joints.
 FIG. 3-48. Grasp and pulp-to pulp pinch have been created. The transplanted ulnar digit is more mobile than the thumb.
CASE 11
This child had congenital absence of parts of all digits on one hand.
 FIG. 3-49. All digits of the child's right hand are represented by small nubbins of various sizes, which move slightly, confirming the presence of proximal structures.
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 FIG. 3-50. A second-toe metatarsal transplant is planned with clay models.
 FIG. 3-51. The transplant is mobilized.
 FIG. 3-52. Positioning of these transplants is critical.
 FIG. 3-53. Several months later, an ulnar digit transplant from the opposite foot is planned.
 FIG. 3-54. Positioning is again preplanned with clay models.
 FIG. 3-55. Good synostoses have been achieved between the toe metatarsals and the hand metacarpals.
 FIG. 3-56. A wide web space has been created.
 FIG. 3-57. Large objects can be grasped and the ability for sensate pulp-to-pulp pinch has been restored.
CASE 12
A child had congenital absence of fingers in both hands. From Buncke, H.J., Harris, G.: Toe-to-hand transplantation in children. In Pediatric Plastic Surgery. Serafin, D., and Georgiade, N., Editors. Vol. 2. St. Louis, C.V. Mosby, 1984.
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