Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 31:
Replantation Surgery


Zone II devascularizing injury was seen in a 2-year-old child.

FIG. 31-09. Injury at this level remains one of the most difficult in which to restore maximum function. Secondary procedures are often necessary to maximize PIP motion and tendon pull-through.

FIG. 31-10. Three-year follow-up shows excellent extension.

FIG. 31-11. DIP pull-through is reduced to the right small finger.

FIG. 31-12. There has been no restriction in growth of the replanted little finger.


This four-finger, Zone II amputation was one of the early cases performed in our unit in 1976, and demonstrates the evolution of our management.

FIG. 31-13. Appearance of hand.

FIG. 31-14. Amputated digits.

FIG. 31-15. Replantation was begun from radial to ulnar, with hand-drilled placement of Kirschner wires. Currently, we begin replantation on the ulnar aspect of the hand first, to restore power grip.


FIG. 31-16. Postoperatively, single longitudinal K-wires are visible in the successful replants. More commonly now, we use crossed wires or intraosseous wires to maintain alignment and allow joint motion earlier in the postoperative period.

FIG. 31-17. Late postoperative result with restored grasp.


A patient had a complex four-finger injury through the PIP joints. Current management includes maximizing function by cross-transplanting fingers to maintain maximal length to the ulnar digits.

FIG. 31-18. Appearance of injury.

FIG. 31-19. X ray.

FIG. 31-20. The dorsal view of the amputated parts reveals the multilevel nature of the ring finger injury (third from left). This finger was discarded, and the long finger amputation replanted in its place.

FIG. 31-21. Intraoperative view. The little finger has been replaced, the index amputation closed, and the index and long amputations shifted to the long and ring positions, respectively.

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