FIG. 31-22. Good postoperative extension.

FIG. 31-23. The index finger stump has poor flexion at the remaining MP joint. A ray amputation is indicated.

CASE 6

This case involved a four-finger amputation to the dominant hand of a 67-year-old man.

FIG. 31-24. Appearance before replantation.

FIG. 31-25. After replantation. Counterincisions were made in the palm to retrieve the divided flexors. The PIP joints of the ring and small finger fused at 30 degrees.

FIG. 31-26. Replantation has restored useful function. Extension.

FIG. 31-27. Flexion. Good index flexion since the amputation was distal to the sublimus insertion.

CASE 7

A patient suffered a three-finger Zone II injury, sparing the PIP joints.

FIG. 31-28. Appearance before replantation.

FIG. 31-29

FIG. 31-30. The little fingertip was replaced as a free composite graft.

FIG. 31-31. Excellent flexion after tenolysis.

CASE 8

A patient had a ring avulsion through Zone II.

FIG. 31-32. In this patient, all extensor and flexor structures were left intact, and the vessels and nerves avulsed at the base of the finger. All joints were spared.

FIG. 31-33. Avulsed part.

FIG. 31-34. Ready for replantation.

FIG. 31-35. The avulsed skin sheath is replaced over the finger. Circulation restored with vein grafts into the distal artery and dorsal veins.

FIG. 31-36. Postoperative dorsal view. There has been complete survival of the avulsed skin with maintenance of joint motion.

FIG. 31-37. Volar view.

CASE 9

next page...