FIG. 31-55. Amputated hand.

FIG. 31-56. The x ray reveals the level of amputation, through the distal radius and ulna.

FIG. 31-57. The amputated hand is explored and volar structures identified.

FIG. 31-58. Dorsal structures are identified and tagged.

FIG. 31-59. A T-plate is used to restore radial bone continuity, preserving wrist motion.

FIG. 31-60. X ray.

FIG. 31-61. Early postoperative result. A split-thickness skin graft was applied to the volar wrist to permit wound closure without tension.

FIG. 31-62. Postoperative function, extension.

FIG. 31-63. Flexion.

FIG. 31-64. Lateral view.

CASE 13

This case involved complete sharp amputation of the dominant hand in a 22-year-old man.

FIG. 31-65. The amputation was through the distal radius and ulna.

FIG. 31-66. Immediately after replantation. Volar view.

FIG. 31-67. Dorsal view.

FIG. 31-68. Late postoperative view, extension.

FIG. 31-69. Pinch. Individual finger flexion.

FIG. 31-70. Small grasp.

FIG. 31-71. Large grasp.

CASE 14

A patient sustained an avulsive hand injury. From Holl, E.J., and Buncke, H.J.: Microsurgical techniques to reconstruct irreparable nerve loss. Orthop. Clin North Am 12:381, 1981.

FIG. 31-72. In this avulsive hand injury, all tendons that cross the wrist were carried with the amputated part.

FIG. 31-73. The avulsed structures have been debrided, and the hand replated with Steinmann pins.

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