FIG. 2-53. The neurovascular island flap has been inserted into the ulnar side of the defect, covering and nourishing the underlying bone and re-establishing the continuity of the digital nerve. One can call this an immediate neurovascular island flap from a non-replantable part.

CASE 11

Hand-to-hand digital transplant was performed in a patient who had sustained amputation of all five fingers of the right hand and part of the index finger of the left hand.

FIG. 2-54. Condition of right hand: only metacarpophalangeal stumps remain.

FIG. 2-55. Left hand: the proximal phalanx of the index finger will be mobilized for transplantation to lengthen the right thumb.

FIG. 2-56. Dorsal view.

FIG. 2-57. Donor phalanx is removed and pinned onto right thumb stump.

FIG. 2-58. Postoperative view shows excellent flexion of new right thumb, almost the same length as the left.

FIG. 2-59. First-web key pinch has restored useful function to the hand.

References

1. Buncke, H.J.: Partial and total finger construction by toe transplantation. Transactions of 4th International Congress of Plastic Surgery. Paris, Masson, p. 69, 1975.

2. Buncke, H.J., and Rose, E.H.: Free toe-to-fingertip neurovascular flaps. Plast. Reconstr. Surg. 63:607, 1979.

3. Alpert, B.S., and Buncke, H.J.: Mutilating multidigital injuries. Use of a free microvascular flap from a nonreplantable part. J. Hand Surg. 3:196, 1978.

4. Hing, D.N., Buncke, H.J., and Alpert, B.S.: To replant or to transplant. Adv. Plast. Reconstr. Surg. 4:177, 1988.

5. Chase, R.A.: The damaged index: A source of components to restore the crippled hand. J. Bone joint Surg. 50A:1152, 1968.

6. White, W.L: Why I hate the index finger. Orthop. Rev. 6:23, 1980.

7. Strickland, J.W.: A rationale for digital salvage. in Difficult Problems in Hand Surgery. Edited by J.W. Strickland and J.B. Steichen. St. Louis, C.V. Mosby, 1982.

next page...