A patient sustained an injury in an industrial weaving loom.

FIG. 31-38. Zone III amputation through the metacarpals.

FIG. 31-39. Amputated part.

FIG. 31-40. Intraoperative view. The palm has been opened to allow isolation of the median nerve and proximal vascular structures.

FIG. 31-41. Extension after multiple reconstructive procedures used to provide maximal function.

FIG. 31-42. Flexion.

CASE 10

A patient had a five-finger devascularizing injury from a table saw.

FIG. 31-43. The injury was through the IP joint of the thumb and proximal phalangeal bases of all four fingers.

FIG. 31-44. Revascularization and reinnervation were performed at the level of the common digital structures for all fingers except the thumb. Extension.

FIG. 31-45. Postoperative function shows good flexion.

FIG. 31-46

CASE 11

A 31-year-old man suffered a bilateral devascularizing injury in a metal bender, creating mirror injuries to both hands across the metacarpal joints.

FIG. 31-47. Right hand.

FIG. 31-48. Left hand.

FIG. 31-49. X ray of right hand.

FIG. 31-50. X ray of left hand.

FIG. 31-51. Simultaneous revascularization of both hands was performed, with seven surgeons rotating in teams for an 11-hour operation.

FIG. 31-52. Postreplantation. Fortunately, both thumbs escaped injury.

FIG. 31-53. Proximal incisions to expose the neurovascular structures are visible in the volar view.

FIG. 31-54. Useful flexion is present.

CASE 12

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