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 FIG. 33-31. Hand after closure of volar and dorsal wounds with a combined latissimus- serratus transplant.
 FIG. 33-32. Thumb opposition was improved with two-stage tendon opponensplasty. X ray shows tendon rod in place.
 FIG. 33-33. Useful key pinch is restored to an otherwise useless hand.
CASE 5
CORRECTIVE OSTEOTOMY
A 13-year-old boy completely amputated his long and index fingers with a table saw.
 FIG. 33-34. Although the fingers were successfully replanted, fracture instability in the long finger required corrective osteotomy.
 FIG. 33-35. X ray of deformity.
 FIG. 33-36. Through a dorsal approach, a wedge osteotomy was performed allowing improved bony contact and correct angulation. Dorsal view.
 FIG. 33-37. Lateral view.
 FIG. 33-38. Six-month follow-up shows improved finger alignment.
CASE 6
ELECTIVE RAY RESECTION
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A 25-year-old man suffered a ripsaw laceration, devascularizing his index and long fingers.
 FIG. 33-39. Appearance of injury.
 FIG. 33-40. X ray shows destroyed MP joint of index.
 FIG. 33-41. Vein grafts were used to restore flow, but a postoperative infection led to tissue loss and extensive scarring over the MP joint of the index finger.
 FIG. 33-42. Rather than undergo multiple procedures to improve function, the patient accepted an elective ray resection of the index.
 FIG. 33-43. X ray.
 FIG. 33-44. After 5 months, the patient has returned to work with good overall hand function. Full flexion.
 FIG. 33-45. Strong grasp.
CASE 7
ELECTIVE RAY RESECTION
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