A 28-year-old metal worker amputated his dominant ring and little fingers in a metal press, avulsing the flexor tendons to the wrist. The digits were successfully replanted, requiring PIP joint fusion, which severely limited ulnar grasp.

FIG. 33-14. Little finger with avulsed tendon.

FIG. 33-15. After replantation.

FIG. 33-16. Limited finger flexion. No grasp.

FIG. 33-17. Two-stage reconstruction was performed, combining silastic arthroplasty with Hunter rod placement.

FIG. 33-18. X ray shows tendon and joint prostheses.

FIG. 33-19. Plantaris grafts ready to replace tendon rods.

FIG. 33-20. Postoperative function remains reduced, but with improved PIP flexion, profundus pull-through and ulnar grip. Immediately postoperatively.

FIG. 33-21. Late follow-up.

CASE 3

Complex hand replantation may require multiple tendon reconstructive procedures. A young factory worker suffered a midmetacarpal hand amputation that was successfully replanted.

FIG. 33-22. Amputation stump.

FIG. 33-23. Amputated part.

FIG. 33-24. Extent of flexion prior to tenolysis.

FIG. 33-25. Palmar tenolysis was performed at 7 months to improve flexion, but was complicated by tendon rupture of the long finger during postoperative therapy.

FIG. 33-26. After Hunter rod placement, a palmaris tendon graft was performed.

FIG. 33-27. At 4 months, there is adequate extension. Palmar view.

FIG. 33-28. Extension, lateral view.

FIG. 33-29. Flexion. Index flexion should improve.

CASE 4

A secondary tendon procedure was performed to improve limited function of the thumb in reconstruction of a severe avulsion injury.

FIG. 33-30. Wound at time of injury.

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