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A similar patient amputated his radial three fingers with a table saw. The long and index fingers had double-level injuries. The long finger was unreplantable, but the thumb-proximal index finger block was successfully replanted.
 FIG. 33-46. X ray of defect.
 FIG. 33-47. Replanted index finger and thumb.
 FIG. 33-48. The index stump was found to be awkward and painful, and hand function was improved by elective ray resection. Extension.
 FIG. 33-49. Flexion.
CASE 8
RAY TRANSPOSITION
A 31-year-old factory worker suffered a nonreplantable four-finger amputation.
 FIG. 33-50. Palmar view.
 FIG. 33-51. X ray of preoperative status.
 FIG. 33-52. Bilateral second toes were transplanted simultaneously to the hand to restore ulnar grip.
 FIG. 33-53. X ray of transplanted toes.
 FIG. 33-54. In an effort to improve key pinch between the thumb and index stump, and widen the first web space, the index proximal phalanx was transferred on an intact vascular pedicle on top of the long finger proximal phalanx stump, and the second metacarpal amputated at its base.
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 FIG. 33-55 A. X ray of transposed index. B. Good key pinch. C. Wide grasp with ulnar toe-fingers.
CASE 9
SILASTIC ARTHROPLASTY
A 23-year-old carpenter completely amputated four fingers of his nondominant hand through the PIP joints of the three ulnar digits.
 FIG. 33-56. Preoperative appearance of wound.
 FIG. 33-57. Result after replantation of the little, ring, and long fingers. The distal index finger was nonreplantable.
 FIG. 33-58. Initial replantation required PIP joint fusion. X ray of hand joints.
 FIG. 33-59. Degree of flexion.
 FIG. 33-60. Silastic arthroplasties were performed through curvilinear dorsal incisions.
 FIG. 33-61. All three joints reconstructed.
 FIG. 33-62. X ray of joints in place.
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