FIG. 28-47. Preoperative radiograph shows the destruction of the metacarpal arch.
FIG. 28-48. Six months later, a simultaneous transplant of a DCIA bone flap and a latissimus were performed. The iliac crest was fixed in place with Steinmann pins, and the bone revascularized through the dorsoradial artery. The latissimus covered the bone and dorsal tissues.
FIG. 28-49. X ray of iliac crest graft supporting the four metacarpals.
FIG. 28-50. Second-stage reconstruction was performed 19 months after the original injury with simultaneous transplantation of a great toe and a rectus muscle to allow pinch and to widen the first web space. X ray of toe transplant in place. The entire first metatarsal joint was carried with the toe. The rectus was anastomosed to the radial artery and the great toe hooked into a side branch from the rectus pedicle.
FIG. 28-51. Pinch restored.
FIG. 28-52. Extension.
A 27-year-old man had suffered a 70% surface area electrical burn, requiring amputation of all digits.
FIG. 28-53. He had pinch and some ability to grasp with the digital stumps on his right hand. The fifth digit stump was very short.
FIG. 28-54. Unstable skin on the left index stump compromised his key pinch.
FIG. 28-55. Reconstruction was performed with the transplantation of five free flaps in three operations. In the first procedures, the thumb was reconstructed with second toe and the index resurfaced with a TPF. The index stump was transferred to the long metacarpal to increase the first web space.
FIG. 28-56. At the second operation, soft tissue coverage to the dorsum and ulna side was provided with a free serratus flap, in preparation for an ulnar toe transplant to improve grasp.
FIG. 28-58. During the third operation, the left hand undergoes a double simultaneous transplant. The right second toe is transplanted to the left small finger position, and the right fifth digit of the right hand is transplanted to the left ring finger position.
FIG. 28-59. Wide three-finger grasp has been provided.