Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 4:
Vascularized Toe Joint Transplantation
  FIG. 4-10. An x ray taken several months after reconstruction was reported by the radiologist as showing "satisfactory healing and alignment of fractures through the proximal and middle phalanxes of the left ring finger."


This patient sustained a power saw injury of the thumb.

FIG. 4-11. Metacarpophalangeal joint area with complete loss of the joint, producing a flail thumb.

FIG. 4-12. X rays reveal residual osteoporotic proximal phalanx and metacarpal remnants.

FIG. 4-13. An arteriogram confirmed the presence of a digital artery to the undamaged radial side of the thumb.

FIG. 4-14. An ipsilateral metatarsophalangeal toe joint transplant was planned, carrying a large dorsal skin island to restore soft tissue loss and correct contractures.

FIG. 4-15. The first dorsal-metatarsal artery plus the communicating branches to the deep first metatarsal artery were dissected out to preserve blood supply to the joint and skin island.

FIG. 4-16. X ray shows how stability was provided with an intramedullary pin across the transplant.


FIG. 4-17. The large skin island has restored the skin defect and protected the underlying vascular and tendon repairs.

FIG. 4-18. Sketch of the anatomic repairs.

FIG. 4-19. Stable pinch has been restored and the patient returned to his work as a carpenter.


1. Buncke, H.J., Jr., et al.: The fate of autogenous whole joints transplanted by microvascular anastomosis. Plast. Reconstr. Surg. 39:333, 1967.

2. Campbell, C.J.: Homo-transplantation of half or whole joint. Clin. Orthop. 87:146, 1975.

3. Eades, J.W., and Peacock, E.E.: Autogenous transplantation of the interphalangeal joint and proximal phalangeal epiphysis: Case report and 10 year follow-up. J. Bone Joint Surg. 48A:775, 1966.

4. Entin, M.A., Alger, J.R., and Baird, R.M.: Experimental and clinical transplantation of autogenous whole joints. J. Bone Joint Surg. 44A:518, 1962.

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