Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 33:
Secondary Reconstruction After Replantation
  FIG. 33-63. Postoperative follow-up shows improved function with tendon pull-though to the distal joint.


A 22-year-old carpenter amputated the tips of his dominant index and long fingers, which were successfully replanted.

FIG. 33-64. Preoperative appearance.

FIG. 33-65. A nonunion occurred at the distal fracture site of the index finger, leading to subluxation and radial deviation. X ray.

FIG. 33-66. Improved bony position and union were achieved with percutaneous placement of a mini-Hoffman bone distraction device.

FIG. 33-67. X ray after distraction.

FIG. 33-68. Interosseous wiring and K-wire fixation.


FIG. 33-69. A 26-year-old carpenter suffered a near-total thumb amputation, entering the carpal tunnel.

FIG. 33-70. X ray of injury.

  FIG. 33-71. Stiffness, scar contracture, and painful neuromas developed at the base of the thumb.

FIG. 33-72. Neuromas of the digital nerves to the thumb.

FIG. 33-73. Sural nerve grafts next to donor wound, left leg.

FIG. 33-74. Improved function was obtained with neurolysis of the median motor nerve and sural nerve graft reconstruction of the digital nerves to the thumb.

FIG. 33-75. Grasp.

FIG. 33-76. Opposition to little finger pulp.


A 38-year-old man suffered an accidental shotgun blast to the right axilla and right arm. The median and ulnar nerves were segmentally destroyed, although the radial nerve survived the humeral injury.

FIG. 33-77. Skin grafted exit wound.

FIG. 33-78. X ray of blast injury to proximal humerus.

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