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11.2 Reconstruction ofType II Defect
a b c
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185
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Fig. 11.9 Reconstruction of type II defect of the left index nger by
the free second toe transplantation. (a) Preoperative condition of the
nger defect. (b) Preoperative X-ray. (c) Preoperative design (dorsal
side). (d) Preoperative design (plantar side). (e) Dissociation of the
blood vessels and nerves. (f) Remove the second toe. (g) Transplantation
Case 2 A 27-year-old female patient was admitted to hospital in emergency for 1.5h due to pain and bleeding of the
left index nger caused by machine crush injury. Physical
examination: She was in good general condition, with stable
vital signs, traumatic loss of the distal segment of the left
index nger from the middle plane of the middle segment of
the nger, exposed bone, irregular skin of the stump, active
bleeding, seriously polluted. After admission, routine preoperative preparation for reconstruction was given, and surgical contraindications were excluded. The index nger was
of the second toe. (h) Palmar view of the reconstructed nger. (i) Dorsal
view of the reconstructed nger. (j) Palmar view of the reconstructed
nger 3 months after the operation. (k) Dorsal view of the reconstructed
nger 3 months after the operation
reconstructed by the left second toe transplantation under
general anesthesia in emergency, and the donor site was
sutured directly. The operation was successful; after the
tourniquet relaxed, the reconstructed nger was ruddy with
moderate tension, wrapped with the sterile cotton, bulked
and stuffed with the broken cotton gauze around, and she
returned to the ward safely. Routine reconstruction treatment was given after the operation, and the reconstructed
nger survived successfully. The efcacy was satisfactory
(Fig.11.9).
186
ab c
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11 Reconstruction ofSingle Finger Defects
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Fig. 11.10 Reconstruction of type II defect of the left index nger
by the free second toe transplantation. (a) Preoperative palmar condition of the nger defect. (b) Preoperative dorsal condition of the nger defect. (c) Preoperative design (dorsal side). (d) Preoperative
design (plantar side). (e) Dissociation of the blood vessels and
nerves. (f) Dissociation of the second toe. (g) Palmar view of the
Case 3 A 31-year-old female patient was admitted to hospital in emergency for 2.5h due to pain and bleeding of the left
index nger caused by machine crush injury. Physical examination: She was in good general condition, with stable vital
signs, traumatic loss of the distal segment of the left index
nger from the middle plane of the middle segment of the
nger, exposed bone, irregular skin of the stump, active
bleeding, seriously polluted. After admission, routine
preoperative preparation for reconstruction was given, and
surgical contraindications were excluded. The index nger
reconstructed nger. (h) Dorsal view of the reconstructed nger. (i)
Palmar view of the reconstructed nger 9 months after the operation.
(j) Dorsal view of the reconstructed nger 9 months after the operation. (k) Function of the reconstructed nger 9 months after the operation. (l) Appearance of the donor and recipient site 9 months after
the operation
was reconstructed by the left second toe transplantation
under general anesthesia in emergency, and the donor site
was sutured directly. The operation was successful; after the
tourniquet relaxed, the reconstructed nger was ruddy with
moderate tension, wrapped with the sterile cotton, bulked
and stuffed with the broken cotton gauze around, and she
returned to the ward safely. Routine reconstruction treatment
was given after the operation, and the reconstructed nger
survived successfully. The efcacy was satisfactory
(Fig.11.10).
11.3 Reconstruction ofType III Defect
187
11.3 Reconstruction ofType III Defect
Type III defect loses 50–80% of the function of the nger,
and the loss of hand function is different in different ngers.
For patients with high requirements for appearance, toe
transplantation can be selected for reconstruction, among
which, the second toe transplantation is the most commonly
used. The donor site of the foot retains the metatarsal head
and transverse ligaments, so it has little effect on the function
of the foot.
11.3.1 Indications
(1) Type III defect of the nger; (2) The patient is young and
has a strong desire for reconstruction; (3) The patient has no
basic disease and there is no obvious deformity of the donor
toe.
11.3.2 Surgical Design
The ipsilateral or contralateral second toe could be selected
to reconstruct the length and shape of the nger, also part of
exion and extension function according to the degree of nger defect.
veins, and 2–3 veins for anastomosis are dissociated, and
then cut off at an appropriate length. Then the plantar skin
is cut open, and one or two veins for anastomosis are dissociated and marked. The bilateral proper arteries, nerves,
and exor tendons are dissociated and cut off according to
the degree of defect of the ngers. The blood vessel stump
is ligated, the broken phalange or joint is dissociated, the
toe is completely disintegrated, and the toe stump is
sutured.
Transplantation
The wound surface of the transplanted toe is repaired to
make the length and size appropriate. Kirschner wires with a
diameter of 0.8–1.0mm are used for crossover and longitudinal xation, or steel wires with a diameter of 0.4mm are
used for crossover xation. The extensor tendon is sutured
with nylon thread. Modied Kessler suture is used to suture
the exor digitorum profundus tendon. Under microscope,
anastomosis is performed on bilateral proper nerves, veins,
and arteries.
Postoperative Treatment
(a) Postoperative intensive nursing and heat preservation; (b)
Blood volume should be maintained and “three anti” therapy
is performed; (c) Do not get out of bed within 1 week after
the operation; (d) Smoking is prohibited during the perioperative period.
11.3.3 Surgical Method
Preparaion fortheRecipient Site
In case of emergency operation, a complete debridement of
the injured nger should be performed rst to remove the
contaminated, contusion and deactivated tissue, and a large
amount of normal saline should be used to ush the wound,
and then disinfect and lay the sheet again. The extensor digitorum tendon, exor digitorum profundus tendon, bilateral
proper digital nerves and arteries, and 2–5 veins are explored
and marked for use. Then debridement and irrigation are performed again under surgical microscope to make the wound
surface in the recipient site meet or close to the standard of
class I incision. If selected, the scar tissue of the stump
should be removed, and the broken bone should be treated
with fresh treatment. Proximal exor tendons are explored
and marked, and bilateral digital arteries, nerves, and veins
are dissociated under microscope.
The Cutting oftheToe
The incision line is drawn on the donor toe according to
the shape and length of the nger defect. The dorsal skin
of the toe is rst cut along the incision line to expose the
11.3.4 Operation Characteristics
Type III defect of nger is a good indication for second toe
transplantation. Because the second toe is removed without
involving the metatarsal and transverse ligaments, there is
little damage to the foot function.
11.3.5 Announcements
(a) Because of the difference in the distribution of blood vessels and nerves between ngers and toes, the blood vessels
and nerves in donor and recipient sites should be kept to a
certain length to facilitate the matching of the anastomotic
site; (b) Most of the blood vessels are small and require
higher microscopic technique; (c) Most exor digitorum
profundus tendons are obviously retracted during elective
operation, requiring longer exor digitorum tendons or tendon transposition; (d) There are obvious differences in the
shape of toes and ngers, which can be repaired in second
stage or modied reconstruction (see the section of modied
reconstruction).
188
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ab c
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11 Reconstruction ofSingle Finger Defects
Fig. 11.11 Reconstruction of type III defect of the right index nger
by the free second toe transplantation. (a) Preoperative condition of the
nger defect. (b) Remove the second toe. (c) Palmar view of the reconstructed nger. (d) Palmar view of the reconstructed nger 11 months
11.3.6 Case Description
Case 1 A 31-year-old male patient was admitted to hospital in emergency for 4h due to pain and bleeding of the
right index nger defect caused by machine injury. Physical
examination: He was in good general condition, with stable
vital signs, middle and distal segment of the right index
nger destroyed. The index nger was debrided and reconstructed by the left second toe transplantation under general
anesthesia in emergency, and the donor site was sutured
directly. The operation was successful; after the tourniquet
relaxed, the reconstructed nger was ruddy with moderate
tension, wrapped with the sterile cotton, bulked and stuffed
with the broken cotton gauze around, and he returned to the
ward safely. Routine reconstruction treatment was given
after the operation, and the reconstructed nger survived
successfully. The efcacy was satisfactory (Fig.11.11).
Case 2 A 43-year-old male patient was admitted to hospital
in emergency for 4h due to pain and bleeding of the right
index nger defect caused by machine injury. Physical
after the operation. (e) Dorsal view of the reconstructed nger 11
months after the operation. (f) Function of the reconstructed nger 11
months after the operation
examination: He was in good general condition, with stable
vital signs, middle and distal segment of the right index nger destroyed. The index nger was debrided and reconstructed by the left second toe transplantation under general
anesthesia in emergency, and the donor site was sutured
directly. The operation was successful; after the tourniquet
relaxed, the reconstructed nger was ruddy with moderate
tension, wrapped with the sterile cotton, bulked and stuffed
with the broken cotton gauze around, and he returned to the
ward safely. Routine reconstruction treatment was given
after the operation, and the reconstructed nger survived
successfully. The efcacy was satisfactory (Fig.11.12).
Case 3 A 34-year-old male patient was admitted to hospital
in emergency for 4h due to pain and bleeding of the right
ring nger defect and the right middle nger injury caused
by machine injury. Physical examination: He was in good
general condition, with stable vital signs, the right ring nger
destroyed from the middle segment. The right hand was
debrided and the ring nger was reconstructed by the right
second toe transplantation under general anesthesia in emer-
11.3 Reconstruction ofType III Defect
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de f
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189
Fig. 11.12 Reconstruction of type III defect of the right index nger
by the free second toe transplantation. (a) Preoperative condition of the
nger defect. (b) Remove the second toe. (c) Transplantation of the
second toe. (d) Condition of the reconstructed nger 7 days after the
operation. (e) Condition of the reconstructed nger 7 days after the
gency, and the donor site was sutured directly. The operation
was successful; after the tourniquet relaxed, the reconstructed nger was ruddy with moderate tension, wrapped
with the sterile cotton, bulked and stuffed with the broken
cotton gauze around, and he returned to the ward safely.
Routine reconstruction treatment was given after the operation, and the reconstructed nger survived successfully. The
efcacy was satisfactory (Fig.11.13).
Case 4
A 28-year-old male patient was admitted to hospital
for more than 2 years due to the right index nger defect
caused by heavy object. Physical examination: He was in
operation. (f) Appearance of the donor site 15 months after the operation. (g) Palmar view of the reconstructed nger 15 months after the
operation. (h) Dorsal view of the reconstructed nger 15 months after
the operation. (i) Function of the reconstructed nger 15 months after
the operation
good general condition, with stable vital signs, the right
index nger destroyed from the middle segment. The index
nger was reconstructed by the right second toe transplantation under general anesthesia electively, and the donor site
was sutured directly. The operation was successful; after the
tourniquet relaxed, the reconstructed nger was ruddy with
moderate tension, wrapped with the sterile cotton, bulked
and stuffed with the broken cotton gauze around, and he
returned to the ward safely. Routine reconstruction treatment
was given after the operation, and the reconstructed nger
survived successfully. The efcacy was satisfactory
(Fig.11.14).
190
ef
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abc
d
11 Reconstruction ofSingle Finger Defects
Fig. 11.13 Reconstruction of type III defect of the right ring nger by
the free second toe transplantation. (a) Preoperative dorsal condition of
the nger defect. (b) Preoperative palmar condition of the nger defect.
(c) Remove the second toe. (d) Transplantation of the second toe. (e)
Transplantation of the second toe. (f) The condition of the reconstructed
nger
ab c
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Fig. 11.14 Reconstruction of type III defect of the right index nger
by the free second toe transplantation. (a) Preoperative palmar condition of the nger defect. (b) Preoperative dorsal condition of the nger
defect. (c) Preoperative design. (d) Remove the second toe. (e)
Transplantation of the second toe. (f) Condition of the reconstructed
nger
11.4 Reconstruction ofType IV Defect
191
11.4 Reconstruction ofType IV Defect
Type IV defect loses more than 80% of the function of the
nger, and the loss of hand function is different in different
ngers. The method for nger reconstruction is similar to
that for type III defect but requires the proximal interphalangeal joint (PIP) reconstruction.
11.4.1 Indications
(1) Type IV defect of the nger; (2) The patient is young and
has a strong desire for reconstruction; (3) The patient has no
basic disease and there is no obvious deformity of the donor
toe.
11.4.2 Surgical Design
The ipsilateral or contralateral second toe could be selected
to reconstruct the length and shape of the nger, also part of
exion and extension function according to the degree of nger defect.
11.4.3 Surgical Method
2–3 veins for anastomosis are dissociated, and then cut off at
an appropriate length. Then the plantar skin is cut open, and
one or two veins for anastomosis are dissociated and marked.
The bilateral proper arteries, nerves, and exor tendons are
dissociated, and cut off according to the degree of defect of
the ngers. The blood vessel stump is ligated, the broken
phalange or joint is dissociated, the toe is completely disintegrated, and the toe stump is sutured.
Transplantation
The wound surface of the transplanted toe is repaired to
make the length and size appropriate. Kirschner wires with a
diameter of 0.8–1.0mm are used for crossover and longitudinal xation, or steel wires with a diameter of 0.4mm are
used for crossover xation. The extensor tendon is sutured
with nylon thread in gure 8 method. Modied Kessler
suture is used to suture the exor digitorum profundus tendon. Under microscope, anastomosis is performed on bilateral proper nerves, veins, and arteries.
Postoperative Treatment
(a) Postoperative intensive nursing and heat preservation; (b)
Blood volume should be maintained and “three anti” therapy
is performed; (c) Do not get out of bed within 1 week after
the operation; (d) Smoking is prohibited during the perioperative period.
Preparaion fortheRecipient Site
In case of emergency operation, a complete debridement of
the injured nger should be performed rst to remove the
contaminated, contusion and deactivated tissue, and a large
amount of normal saline should be used to ush the wound,
and then disinfect and lay the sheet again. The extensor digitorum tendon, exor digitorum profundus tendon, bilateral
proper digital nerves and arteries, and 2–5 veins are explored
and marked for use. Then debridement and irrigation are performed again under surgical microscope to make the wound
surface in the recipient site meet or close to the standard of
class I incision. If selected, the scar tissue of the stump
should be removed, and the broken bone should be treated
with fresh treatment. Proximal exor tendons are explored
and marked, and bilateral digital arteries, nerves, and veins
are dissociated under microscope.
The Cutting oftheToe
The incision line is drawn on the donor toe according to the
shape and length of the nger defect. The dorsal skin of the
toe is rst cut along the incision line to expose the veins, and
11.4.4 Operation Characteristics
Type IV defect is a good indication for second toe transplantation, which needs to be removed near the proximal interphalangeal joint; the function of the foot is relatively
damaged.
11.4.5 Announcements
(a) Because of the difference in the distribution of blood vessels and nerves between ngers and toes, the blood vessels
and nerves in donor and recipient sites should be kept to a
certain length to facilitate the matching of the anastomotic
site; (b) Most of the blood vessels are small and require
higher microscopic technique; (c) Most exor digitorum
profundus tendons are obviously retracted during elective
operation, requiring longer exor digitorum tendons or tendon transposition; (d) There are obvious differences in the
shape of toes and ngers.
192
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11 Reconstruction ofSingle Finger Defects
Fig. 11.15 Reconstruction of type IV defect of the right middle nger
by the free second toe transplantation. (a) Preoperative dorsal condition
of the nger defect. (b) Preoperative palmar condition of the nger
defect. (c) Remove the second toe. (d) Transplantation of the second
toe. (e) Condition of the reconstructed nger. (f) Condition of the
11.4.6 Case Description
Case 1 A 29-year-old male patient was admitted to hospital
for more than 1 year due to the right middle nger defect
caused by machine injury. Physical examination: He was in
good general condition, with stable vital signs, the right middle nger destroyed from the proximal interphalangeal joint,
and the stump healed well. The index nger was reconstructed by the right second toe transplantation under general
anesthesia electively, and the donor site was sutured directly.
The operation was successful; after the tourniquet relaxed,
the reconstructed nger was ruddy with moderate tension,
wrapped with the sterile cotton, bulked and stuffed with the
broken cotton gauze around, and he returned to the ward
safely. Routine reconstruction treatment was given after the
operation, and the reconstructed nger survived successfully.
reconstructed nger. (g) Appearance of the reconstructed nger 10
months after the operation. (h) Appearance of the reconstructed nger
10 months after the operation. (i) Function of the reconstructed nger
10 months after the operation
The efcacy was satisfactory and the donor site healed in
rst stage (Fig.11.15).
A 41-year-old female patient was admitted to hospi-
Case 2
tal in emergency for 3h due to pain and bleeding of the right
index and middle ngers caused by machine injury. Physical
examination: She was in good general condition, with stable
vital signs, the right index nger destroyed from the proximal interphalangeal joint, and the skin defect and tendon
exposed in the middle and distal phalanx of the right middle
nger. The right hand was debrided and the index nger was
reconstructed by the right second toe transplantation and the
middle nger repaired by reverse digital artery island ap
under general anesthesia in emergency, and the donor site
was sutured directly. The operation was successful; after the
tourniquet relaxed, the reconstructed nger was ruddy with
moderate tension, wrapped with the sterile cotton, bulked
ef
hi
11.5 Reconstruction ofType V Defect
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d
g
193
Fig. 11.16 Reconstruction of type IV defect of the right index nger
by the free second toe transplantation. (a) Preoperative condition of the
nger defect. (b) Remove the second toe. (c) Transplantation of the
second toe. (d) Repair the middle nger. (e) Condition of the reconstructed nger. (f) Dorsal view of the reconstructed nger 13 months
and stuffed with the broken cotton gauze around, and she
returned to the ward safely. Routine reconstruction treatment
was given after the operation, and the reconstructed nger
survived successfully. The efcacy was satisfactory and the
donor site healed in rst stage (Fig.11.16).
11.5 Reconstruction ofType V Defect
Type V defect of the nger would lose most or all of the
function of the nger, according to the degree of different
nger defects, functional effects and the requirements of the
patient, operation should be carefully selected. For operation, the range of type V defect is large, and the operation
plan should be selected according to different nger and
after the operation. (g) Palmar view of the reconstructed nger 13
months after the operation. (h) Function of the reconstructed nger 13
months after the operation. (i) Situation of the donor site 13 months
after the operation
stump length. If the injured nger is short and the stump of
the proximal nger is long, while the length of the second toe
can meet the needs of reconstruction, the nger can be reconstructed according to type IV defect. On the another situation
that the injured nger is long and the stump of the proximal
nger is short, while the length of the second toe cannot meet
the needs of reconstruction, bone graft should be considered
to reconstruct the length.
11.5.1 Indications
(1) Type V defect of the nger; (2) The patient is young and has
a strong desire for reconstruction; (3) The patient has no basic
disease and there is no obvious deformity of the donor toe.
194
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11 Reconstruction ofSingle Finger Defects
11.5.2 Surgical Design
Different methods should be selected according to the length
of the second toe and the residual length of injured nger. If
the length of the second toe can meet the needs of reconstruction, choose the reconstruction method for type IV
defect. If the length of the second toe is not sufcient for
reconstruction, iliac bone grafts could be used.
11.5.3 Surgical Method
Preparaion fortheRecipient Site
In case of emergency operation, a complete debridement
of the injured nger should be performed rst to remove
the contaminated, contusion and deactivated tissue, and a
large amount of normal saline should be used to ush the
wound, and then disinfect and lay the sheet again. The
extensor digitorum tendon, exor digitorum profundus
tendon, bilateral proper digital nerves and arteries, and
2–5 veins are explored and marked for use. Then debridement and irrigation are performed again under surgical
microscope to make the wound surface in the recipient
site meet or close to the standard of class I incision. If
selected, the scar tissue of the stump should be removed,
and the broken bone should be treated with fresh treatment. Proximal exor tendons are explored and marked,
and bilateral digital arteries, nerves, and veins are dissociated under microscope.
The Cutting oftheToe
If the length of the second toe can meet the needs of reconstruction, cut it according to type IV defect. If the length of
the second toe cannot be satised, the dorsal ap of the foot
should be carried and cut according to the method of type V
defect of the thumb.
Transplantation
The wound surface of the transplanted toe is repaired to
make the length and size appropriate. Kirschner wires with a
diameter of 0.8–1.0mm are used for crossover and longitudinal xation, or steel wires with a diameter of 0.4mm are
used for crossover xation. The extensor tendon is sutured
with nylon thread in gure 8 method. Modied Kessler
suture is used to suture the exor digitorum profundus tendon. Under microscope, anastomosis is performed on bilateral proper nerves, veins, and arteries.
Postoperative Treatment
(a) Postoperative intensive nursing and heat preservation; (b)
Blood volume should be maintained and “three anti” therapy
is performed; (c) Do not get out of bed within 1 week after
the operation; (d) Smoking is prohibited during the perioperative period.
11.5.4 Operation Characteristics
The proximal segment of the nger is long, and the range of
type V defect of the nger is large, accounting for about half
of the nger. Therefore, the surgical plan should be determined according to the length of the residual stump.
11.5.5 Announcements
(a) Because of the difference in the distribution of blood vessels and nerves between ngers and toes, the blood vessels
and nerves in donor and recipient sites should be kept to a
certain length to facilitate the matching of the anastomotic
site; (b) Most of the blood vessels are small and require
higher microscopic technique; (c) Most exor digitorum
profundus tendons are obviously retracted during elective
operation, requiring longer exor digitorum tendons or tendon transposition; (d) There are obvious differences in the
shape of toes and ngers.
11.5.6 Case Description
Case 1 A 35-year-old female patient was admitted to hospital for more than 1 year due to the right index nger defect
caused by heavy object. Physical examination: She was in
good general condition, with stable vital signs, the right
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