|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| A 42-year-old architect suffered a clean amputation of his left thumb by a hand-held rotary saw. The thumb was completely transected through the proximal phalanx without joint injury.
FIG. 32-4 Early postoperative view shows restoration of the thumb position and maintenance of length. After minimal bony shortening, crossed Kirschner wires have been placed to provide fixation without joint impingement. Wires are usually drilled into the amputated part first, and then driven retrograde into the stump. Care is taken to compress the bone fragments during drilling to limit distraction caused by the second wire.
A patient sustained complete thumb amputation after a table saw accident.
FIG. 32-06. A single 0.045 inch K-wire has been driven retrograde into the proximal stump. Note the needle transfixing the flexor pollicis longus to prevent retraction. Single wires, placed either obliquely or through the medullary cavity, usually provide adequate fixation in fractures distal to the sublimis insertion, where the forces acting to deform the fracture are reduced.
| FIG. 32-07. X ray shows placement.
A 27-year-old man suffered a three-finger amputation through the proximal phalanges and the PIP joint of the long finger in a sheet-metal cutter. There was a closed dislocation of the long finger DIP joint.
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