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246
16 Reconstruction ofDorsal Digital Composite Tissue Defects
neal nerve from the sensory nerve of the ap, and a sharp
separation is made medially under the deep fascia. Cut
the extensor digitorum longus tendon longitudinally
when the ap crosses it, so that the ap carries 1/2 extensor digitorum longus tendon. After crossing the extensor
digitorum longus tendon, dissociation should be close to
the periosteum, and the dorsal metatarsal artery is dissociated at the toe web, followed retroactively from the
distal to the proximal, and the arteries and veins should
be carefully protected during the operation. Then cut the
skin along the designed line until the ap is completely
dissociated, and the blood vessel pedicle should be kept
continuously. After the tourniquet is relaxed, the pedicle
should be cut off after the ap is ruddy in color.
(b) Transposition of the ap: Firstly, according to the defect
of the extensor digital tendon, the 1/2 extensor digitorum
longus tendon and the extensor digital tendon are sutured.
If accompanied by central bundle insertion or extensor
digital tendon defect, reconstruction of central bundle or
extensor digital tendon insertion should be performed.
After the reconstruction, anastomosis of metatarsal-digital artery, dorsal foot vein and dorsal hand vein, cutaneous branch of supercial peroneal nerve, and digital
nerve should be performed sequentially.
(c) Postoperative treatment: Prevention of infection, vaso-
spasm, thrombosis, bed rest immobilization, and other
treatments should be given for 7–10 days. Dressing is
changed once every 1–3 days, and functional rehabilitation exercises are guided after suture removal 2 weeks
later.
16.4 Operation Characteristics
(a) It can avoid the deciency of previous ap repair and
tendon transplantation repair in the second stage.
(b) Emergency debridement is easy to clearly identify the
anatomical structures of various tissues and their relationships, and understand the injury plane and scope of
blood vessels, nerves, tendons, and other tissues.
(c) Emergency treatment of the wound can be performed
when the tissue has not undergone severe trauma
response and secondary pathological changes such as
contracture and adhesion from granulation tissue or scar
hyperplasia. The complete excision of the deactivated
and heavily polluted tissue can avoid excessive or less
excision of the tissue and misexcision and create conditions for the repair of the hand-wound and functional
recovery.
(d) It can not only make patients early functional rehabilita-
tion, but also reduce the pain and medical costs of multiple operations.
16.5 Announcements
(a) At the dorsal side of the proximal segment, the lateral
band formed by lumbrical muscle and interosseous muscle should be sutured to reconstruct the insertion point
on both sides of the repaired tendon as far as possible.
(b) If the wound is located at the central band insertion or
distal extensor tendon insertion of the middle dorsal segment of the nger, reconstruction should be needed to
restore the continuity of the tendinous anatomical structure of the dorsal nger.
16.6 Case Description
Case 1 The 26-year-old male patient was admitted to the
hospital for 1.5 h due to pain and bleeding of the left middle
nger caused by planer injury. Physical examination: soft
tissue defect on the dorsal side of the proximal segment of
the left middle nger with exposed bone, exion deformity,
and the defect area was 3.0 × 2.0 cm. X-rays showed no
obvious signs of fracture, only a cortical defect on the dorsal
side of the third phalanx. After admission, routine preoperative preparation for reconstruction was given, and surgical
contraindications were excluded. After complete emergency
debridement, the nger was reconstructed by transposition
of composite tissue ap on the ipsilateral second toe under
brachial plexus epidural anesthesia in emergency, and the
donor site was covered by skin graft. The ap area was 3.5 ×
2.2cm. The operation was successful, routine reconstruction
treatment was given after the operation. Eight years of regular follow-up were conducted to guide functional exercise.
The appearance and function of the reconstructed nger
were satisfactory (Fig.16.1).
Case 2 The 29-year-old male patient was admitted to the
hospital for 1.5 h due to pain and bleeding of the left thumb
caused by a planer injury. Physical examination: Soft tissue
defect on the dorsal side of the left thumb with exposed bone,
irregular wound, seriously polluted, and the defect area was
7.5 × 2.0cm. After admission, routine preoperative preparation for reconstruction was given, and surgical contraindications were excluded. After complete emergency debridement,
the nger was reconstructed by transposition of the ipsilateral great toe nail ap under brachial plexus epidural anesthesia in emergency, and the donor site was covered by skin
graft. The ap area was 8.0 × 2.2cm. The operation was
successful, routine reconstruction treatment was given after
the operation. Six months of regular follow-up was conducted to guide functional exercise. The appearance and
function of the reconstructed nger were satisfactory
(Fig.16.2).
16.6 Case Description
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247
a
d
g
b
e
h
c
f
i
j
Fig. 16.1 Reconstruction of composite tissue defect of the left middle
nger by transposition of composite tissue ap of the ipsilateral second
toe. (a) Preoperative condition of the nger defect. (b) The condition of
the nger defect after debridement. (c) Preoperative design. (d)
Dissociation of the ap. (e) Dissociation of the vascualr pedicle. (f)
Transposition of the ap. (g) The dorsal view of the reconstructed nger
8 years after the operation. (h) The palmar view of the reconstructed
nger 8 years after the operation. (i) The function of the reconstructed
nger 8 years after the operation. (j) The situation of the donor site 8
years after the operation
248
ef
16 Reconstruction ofDorsal Digital Composite Tissue Defects
ab c
d
g
Fig. 16.2 Reconstruction of composite tissue defect of the left thumb
by transposition of the ipsilateral great toe nail ap. (a) Preoperative
condition of the nger defect. (b) Preoperative design. (c) Dissociation
of the ap. (d) Transposition of the ap. (e) The appearance of the
reconstructed nger 4 months after the operation. (f) The function of
the reconstructed nger 4 months after the operation. (g) The situation
of the donor site 4 months after the operation
Special Types ofFinger Reconstruction
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17
Abstract
In the history of nger reconstruction, there are many key
gures and landmark surgical methods, which have had a
decisive impact on the later generations. In recent years,
some scholars have made a lot of explorations in the reconstruction methods, especially in the aspect of aesthetics and
shape, and put forward the methods and concepts of “aesthetic reconstruction” and “comprehensive reconstruction,”
so that the thumb and nger reconstruction is transformed
from a simple “moving” and “transplantation” to a reconstruction mode aiming at restoring the appearance and
function of the original nger as far as possible. But no
matter what method is used to reconstruct the thumb or nger, free-toe transplantation is still the most widely used
method in the clinic. With the rapid development of microsurgery technology and the concept of “super microsurgery,” nger reconstruction has been improved continuously
depending on the specic situation of the defect tissue, and
is getting closer to the ideal perfect level.
Keywords
Finger reconstruction · Special types
of the metatarsophalangeal joint is bloated, the metatarsophalangeal joint is hyperextension in the resting state, and the position of the bone and joint moves forward. Therefore, many
patients are not satised with the appearance and function of
the reconstructed nger after the second toe transplantation.
For this reason, Cheng etal. put forward the concept of decorative reconstruction to improve the appearance of the reconstructed ngers which mainly focuses on the following three
aspects: nail elongation, correction of the plantar isthmus, and
removal of the enlarged part of the toe pulp.
17.1.1 Indications
(a) Same as various nger reconstruction; (b) Patients with
high requirements for nger appearance.
17.1.2 Surgical Design
The second toe is removed as before and the shape of the toe
is reshaped as needed which includes three aspects: nail
elongation, correction of the plantar isthmus, and removal of
the enlarged part of the toe pulp.
17.1 Aesthetic Reconstruction
(Comprehensive Reconstruction)
Aesthetic nger reconstruction is a surgical procedure to repair
and reconstruct the thumb or nger defect for aesthetic purposes which belong to the category of partial reconstruction.
Compared with the thumb and nger, the shape and function of
the second toe are quite different. Fingers are relatively thick
and long, the size is symmetrical, the ngertip is a natural cone,
the nail is large, the metacarpophalangeal joint has not too
much fat accumulation, the rest position of the interphalangeal
joint, metacarpophalangeal joint is slightly exed, etc. While
the toes are thin and short, the distal toe pulp is enlarged and
clubbed, the neck is small, the subcutaneous fat accumulation
© Springer Nature Singapore Pte Ltd. 2023
J. Lin et al., Atlas of Finger Reconstruction, https://doi.org/10.1007/978-981-19-9612-2_17
17.1.3 Surgical Method
Preparation fortheRecipient Site
Same as the second toe transplantation.
The Cutting oftheToe
Same as the second toe transplantation. The method of
remodeling the second toe is as follows: (a) The nail body
should be lengthened and enlarged. A transverse incision of
the dorsal distal interphalangeal joint is performed to make a
rectangular piece of skin, dissociation is between the nail
fold and the nail bed. Then the incision is drawn and sutured
to make the nail fold backward.
249
250
17 Special Types ofFinger Reconstruction
(a) If it is the distal segment defect, and the narrow part of the
middle segment of the second toe is not obvious, at the
same time the circumference is similar to that of the affected
nger, while the two sides of the toe pulp are symmetrically
enlarged, the “eight” word incision on both sides of the toe
pulp should be performed to remove the enlarged part on
both sides and directly suture the incision.
(b) If the distal segment of the second toe is not signicantly
enlarged but the plantar stenosis is obvious, the bular
island ap of the great toe is transposition and inserted
into the plantar stenosis of the middle segment for thickening. Before the ap is inserted, a longitudinal incision
is made on the plantar side of the middle segment of the
second toe, and the skin on both sides is dissociated on
the surface of the tendon sheath. The ap should be
designed with the bular plantar digital artery of great
toe as the axis. The width of the ap should be the difference between the circumferential diameter of the narrow
part of the middle segment of the second toe at the donor
site and the circumferential diameter of the thumb and
nger at the corresponding position of the recipient site.
The length should be the distance between the base of
the distal segment of the plantar side of the second toe
and the toe web.
(c) If the distal segment of the second toe is only bular
enlargement and the stenosis of the middle segment is
light, the pedicled ap of the bular side of the second
toe pulp is used to improve the bular enlargement of the
second toe and correct the plantar stenosis deformity of
the middle segment.
(d) If the second toe is simply enlarged in the middle of the
toe pulp and the stenosis is obvious, longitudinal fusiform
direct incision of the skin in the middle of the toe pulp is
used. The width of resection was the difference between
the circumferential diameter of the most enlarged part of
the second toe and that of the distal segment of the adjacent nger of the recipient’s nger. At the same time, the
bular island ap of great toe is transferred to reconstruct
the plantar stenosis of the middle segment.
Transplantation
The second toe is dissociated according to the routine, the fractures are xed with Kirschner wires vertically or across, and the
tendons are sutured by adjusting the tension. IV type or above
defect of thumb and nger, the reconstructed digital artery and
nerve are anastomosed with the radial artery of snuff box and
supercial branch of radial nerve, while the accompanying
vein or subcutaneous vein is anastomosed. Below IV type
defect, the reconstructed digital artery and nerve are anastomosed with proper digital artery and nerve of the recipient site,
while the subcutaneous dorsal digital vein is anastomosed.
Postoperative Treatment
(a) Postoperative nursing, heat preservation, and close observation of blood circulation; (b) Use of antibiotics, anticoagu-
lant, and antispasmodic drugs; (c) Protective passive function
exercise is performed at 3 weeks after the operation, and systematic active and passive function exercise is performed at
4 weeks after the operation while plaster removal and internal xation are removed.
17.1.4 Operation Characteristics
(a) This operation is a modication of the second toe trans-
plantation with the aim of improving the postoperative
appearance.
(b) The operation needs to solve the main problems affect-
ing the appearance according to the specic conditions
of the toes. There are many specic methods, which
need to be mastered exibly.
(c) Familiarity with nger and toe blood supply and ap
transposition is required.
17.1.5 Announcements
(a) The shape of the second toe and the corresponding con-
tralateral nger should be carefully measured before the
operation, and the operation plan is designed according
to the principle of “reducing fat and replenishing
weight.”
(b) The main purpose of this operation is to improve the
appearance, which requires careful design of the incision in the donor and recipient sites.
(c) The dilatation of the narrow segment of the second toe is
only applicable to the nger defect above type III and
the adjacent ngers are thicker.
17.1.6 Case Description
Case 1 The 23-year-old female patient was admitted to the
hospital for 8 weeks due to the right defect. Physical examination: She was in good general condition, with stable vital
signs, and distal segment defect of the right thumb. After
admission, routine preoperative preparation for reconstruction was given, and surgical contraindications were excluded.
The thumb was reconstructed by the great toe nail ap combined with an Iliac bone graft under general anesthesia, and
the donor's foot was repaired by a reverse medial plantar
island ap. 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. Twenty-four months of regular
follow-up was conducted to guide functional exercise. The
appearance and function of the reconstructed nger were satisfactory (Fig.17.1).
hi
kl
17.1 Aesthetic Reconstruction (Comprehensive Reconstruction)
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abc
251
d
e
f
g
j
mn o
Fig. 17.1 Aesthetic reconstruction of type II defect of the right thumb.
(a) Preoperative condition of thumb defect. (b) Preoperative design of
the recipient site. (c) Preoperative X-ray. (d) Preoperative design of the
donor site. (e) Preoperative design of the ap. (f) Preoperative design of
the iliac bone graft. (g) Phalanx formation. (h) Dissociation of the ap.
(i) Transposition of the ap. (j) The great toe was repaired by the ap.
(k) The ap donor site is covered by skin graft. (l) The reconstructed
thumb survived 7 days after the operation. (m) The X-ray of the reconstructed thumb 15 months after the operation. (n) The palmar view of
the reconstructed thumb 24 months after the operation. (o) The dorsal
view of the reconstructed thumb 24 months after the operation. (p) The
function of the reconstructed thumb 24 months after the operation. (q)
The situation of the donor great toe 24 months after the operation. (r)
The situation of the donor ap site 24 months after the operation
252
pqr
Fig. 17.1 (continued)
17 Special Types ofFinger Reconstruction
17.2 Finger Reconstruction inChildren
Finger reconstruction in children is one of the serious treatment methods for the important nger loss, which seriously
affects the function and appearance of the hand. In particular, the second toe is transplanted to reconstruct the missing
nger to reconstruct function and appearance. Compared
with adult nger reconstruction, nger reconstruction in
children still has its particularity: (a) The blood vessels in
children are tiny, which are difcult to be anastomosed; (b)
The children’s mental development is not complete, that
they cannot fully cooperate with the treatment after the
operation; (c) Limitations of medication, etc. Until the
1970s, the development of hardware such as surgical microscopes, ne microscopic instruments, and microstructures
laid the foundation for nger reconstruction in children. Of
course, nger reconstruction in children is not only difcult
and time- consuming but also has a relatively high risk of
success rate. This is a problem that must be considered in
practical work.
17.2.1 Indications
Incomplete ngers in children seriously affect their physiological and psychological development and have high
requirements for appearance and function after reconstruction. Therefore, reconstruction should be performed as long
as the physical condition of the child permits, the proximal
vascular condition of the nger is good, and the function of
the reconstructed nger can be predicted.
17.2.2 Surgical Design
Because children are active and do not cooperate with treatment, so anesthesia needs to be safe and reliable. The operation time is long and needs to make full preparation before
the operation. The blood circulation of the ngers should be
observed closely after the operation. When necessary, an
appropriate amount of sedative drugs can be used. The
proper plantar digital artery of toe is selected, which is constant, not affected by the variation of dorsal foot artery, and
has the advantages of little injury to children that quick
postoperative recovery and satisfactory function are
possible.
17.2.3 Surgical Method
Preparation fortheRecipient Site
The size, scope, and characteristics of the defect should be
measured before operation. Complete debridement is performed during the operation, the visible blood vessels and
nerves are exposed and protected under the microscope
which should not be easily ligated but marked for
anastomosis.
The Cutting oftheToe
(a) Reconstruction of type I nger defect: First, the dorsal
digital vein of the great toe is dissociated on the dorsum
of the great toe and dissociated proximally to an appropriate length before being cut off, and then dissociated
along the vein branch to the bular end of the great toe
to the tip. The dorsal metatarsal artery and plantar metatarsal artery as well as the bular plantar digital artery of
the great toe emitted after anastomosis are dissociated at
the toe web. After dissociating the artery and nerve of
the bular plantar of the great toe, the transverse artery
is cut and ligated, and the nerve bundle of the artery and
nerve bundle is further dissociated distally to the proximal end of the ap. The skin is cut along the design line
in the toe pulp, and several supercial toe veins are carefully dissociated proximally for 1–2cm before being cut
off for use. The subcutaneous tissue of the toe pulp is
further cut deep to the bular side of the bone. Cut the
toenail on the tibial side and proximal side to the periosteum according to the design line. With a ne milling
drill cutting the dorsal side and tibial side of bone, a
bone knife separates bone cortex of the bular and tibial
17.2 Finger Reconstruction inChildren
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253
sides, together with part of the toenail and the ap. The
plantar digital artery and nerve of the great toe should be
cut off at the appropriate length.
(b) Reconstruction of types II and III nger defect: The dor-
sal digital vein of great toe is dissociated on the dorsum
of the great toe and dissociated proximally to an appropriate length before being cut off, and then dissociated
along the vein branch to the bular end of the great toe
to the tip. The dorsal metatarsal artery and plantar metatarsal artery as well as the bular plantar digital artery of
great toe emitted after anastomosis are dissociated at the
toe web. After dissociating the artery and nerve of the
bular plantar of the great toe, the transverse artery is cut
and ligated. The skin is cut along the design line in the
toe pulp, and the ap is dissociated subcutaneously to
the bular side of the bone. According to the design line,
the tibial side of the toenail is cut to the periosteum, and
the dorsal bone cortex of the phalanx is cut with a milling cutter. The dorsal toe ap is lifted distally from the
surface of the periapendoneum to the insertion point of
the extensor digitorum longus tendon. A ne milling cutter is used to cut the dorsal phalangeal cortex and tibial
cortex far from the extensor longus tendon. The dorsal
phalangeal cortex is separated from the tibial plantar
cortex with a bone knife, and part of the toenails and the
ap are dissociated together. The bular plantar artery
and nerve of the great toe should be cut off at the appropriate place. The phalanges in the composite tissue ap
are trimmed, and the length is measured. If the length
could not reach the required length of the reconstructed
nger, the iliac bone or allograft bone should be taken
for reserve. For those requiring repair of the distal interphalangeal joint, the second interphalangeal joint is
grafted.
(c) Reconstruction of Type IV nger defect: The ap should
be removed through the designed incision at the great
toe and the second toe as the donor site. The dorsal metatarsal ap is cut open to expose the supercial dorsal
metatarsal vein and dissociated distally to the dorsum of
the great toe and second toe to nd the main supercial
veins as the return veins. Dissociate the deep peroneal
nerve, the rst dorsal metatarsal artery, the rst plantar
metatarsal artery, the bular proper plantar digital artery
and nerve of the great toe and the tibial proper plantar
digital artery and nerve of the second toe. If the rst dorsal metatatsal artery is absent or thin, the longer plantar
metatarsal artery can be cut as tissue ap artery. The
incision is extended to the dorsal side and the plantar
side, respectively, and the extensor longus tendon, deep
and supercial exor tendons of the second toe are dissociated. The length of the tendon is determined according to the condition of the recipient site. The toenail ap
is cut according to the designed width of the nail and
osteotomy is performed on the proximal end of the toenail root of the terminal tarsal toe, so that the phalanx of
the terminal toe can be attached to the toenail ap.
Then carefully dissociate and cut the composite tissue ap of the proximal interphalangeal joint of the second toe with the middle segment and the proximal
phalangeal bone. A suitability length iliac bone strip is
cut behind the anterior superior iliac spine 2cm from the
iliac crest. Before suturing the skin, according to the
condition of the skin defect of the donor foot, cut the
appropriate size of spindle-shaped strip along the incision, and then pull it together to suture the wound. If a
free inguinal ap is required to repair a foot wound, dissociation of the ap should be performed before the iliac
crest is removed.
(d) Reconstruction of type V nger defect: The proximal
phalanx body is missing in type V nger defect. It is
necessary to take one more ilium bone and place it in the
position of the proximal phalanx to solve the problem of
the proximal phalanx defect.
(e) Reconstruction of type VI nger defect: On the basis of
type IV defect, the ipsilateral or contralateral second
metatarsophalangeal joint is transplanted to reconstruct
the metacarpophalangeal joint.
(f) Treatment of donor foot: For the case with four toes
retained, the residual toenail ap of the second toe can
be combined with the great toe stump and internal xation with Kirschner wire, and the skin is sutured. The
dorsal metatarsal wound could be covered by free aps
or free skin graft. The donor site of the toe joint can be
lled with an iliac bone of the same size through
Kirschner wire xation. In the case of keeping 5 toes,
foot ap or groin ap transplantation can be used to
repair the donor wound.
Transplantation
The great toenail skin is rolled into a tube and the proximal
interphalangeal joint of the second toe should be placed in an
appropriate position. The defect between the phalangeal
bone in the joint and the great toenail ap is lled with iliac
bone strips. A 1.0mm diameter Kirschner wire is used to
string the three together to form a new nger, which would
be transplanted to the stump of the nger to be reconstructed.
The great toenail ap can be transplanted with the second toe
joint in the same pedicle, or the tibial plantar digital artery of
the second toe can be cut off from the proximal starting
point, and then the plantar artery of the second toe and the
artery of the toenail ap can be anastomosed with the corresponding proximal proper digital artery respectively after
being wrapped. Suture the extensor and exor tendons with
tendon threads. If the great toenail ap is successfully
wrapped around the phalangeal artery without disconnection, the dorsal metatarsal artery (or plantar metatarsal
254
17 Special Types ofFinger Reconstruction
artery) can be anastomosed with the ipsilateral proper digital
artery or palmar digital artery of the reconstructed nger. If
the artery is disconnected, the bular plantar artery of the
great toe and the tibial plantar artery of the second great toe
can be anastomosed with the ipsilateral proper digital artery
of the reconstructed nger, respectively. Then the veins of
the great toenail ap and the second toe are anastomosed
with the supercial subcutaneous veins of the dorsal hand.
Finally, the bular plantar nerve of the great toe and the tibial
plantar nerve of the second great toe are anastomosed with
corresponding proper digital nerves of the reconstructed
nger.
Postoperative Treatment
(a) After the operation, intensive nursing and close observa-
tion of the reconstructed nger should be carried out.
(b) Routine treatment of “three antitherapy” after the
operation.
17.2.4 Announcements
(a) The infant nger (toe) body is small and the blood vessels
and nerves are tiny which are usually anastomosed under the
microscope 18–24 times to ensure the quality of the anastomosed blood vessels that can increase the reux and reduce
the venous crisis; (b) Cross Kirschner wires are used for
bone xation and the epiphysis and nail bed should be protected as much as possible; (c) Long arm plaster support is an
auxiliary condition that cannot be ignored after the operation; (d) Infant compliance is poor, that can be combined
with early “hibernation therapy” to reduce vascular crisis
caused by the postoperative limb movement and pain.
17.2.5 Case Description
Case 1 A 10-year-old male patient was admitted to the hospital for 7 days after stump repair due to the right thumb
defect caused by a machine injury. Physical examination: He
was in good general condition, with stable vital signs, ngertip defect, scabbed wound, and blood supply of the other
ngers was normal. After admission, routine preoperative
preparation for reconstruction was given, and surgical contraindications were excluded. The thumb was reconstructed
by a half great toe tip composite ap under general anesthesia in a selective time, and the donor site was performed
stump repair. 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. Eight months after the operation,
the reconstructed nger survived successfully. Regular follow- up was conducted to guide functional exercise. The
appearance and function of the reconstructed nger were satisfactory (Fig.17.2).
Case 2 The 12-year-old male patient was admitted to the
hospital for 10 days after nger replantation due to necrosis
of the distal segment of the right index nger caused by
punch injury. Physical examination: he was in good general
condition, with stable vital signs, the distal segment of the
right index nger was necrotic with a clear boundary. After
admission, routine preoperative preparation for reconstruction was given, and surgical contraindications were
excluded. The index nger was reconstructed by the left
second toe transplantation under general anesthesia in a
selective time, and the donor site was performed stump
repair. 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. Seven months after the operation, the
reconstructed nger survived successfully. Regular followup was conducted to guide functional exercise. The appearance and function of the reconstructed nger were
satisfactory (Fig.17.3).
Case 3 The 9-year-old female patient was admitted to the
hospital for 1.5 h in an emergency due to pain and bleeding
of the left second to fth ngers caused by modeling injury.
Physical examination: she was in good general condition,
with stable vital signs, type V defect of the left second to fth
ngers, exposed bones, irregular wound, and seriously polluted. After admission, routine preoperative preparation for
reconstruction was given, and surgical contraindications
were excluded. The ngers were reconstructed by the bilateral second and third toes transplantation under general anesthesia in an emergency, and the donor site was performed
stump repair. The operation was successful, after the tourniquet relaxed, the reconstructed ngers were 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. Ten months after the operation, the
reconstructed ngers survived successfully. Regular follow up was conducted to guide functional exercise. The appearance and function of the reconstructed ngers were
satisfactory (Fig.17.4).
17.2 Finger Reconstruction inChildren
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ab c
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Fig. 17.2 Reconstruction of type I defect of the right thumb in a child
by the left great toenail ap. (a) Preoperative dorsal condition of thumb
defect. (b) Preoperative palmar condition of thumb defect. (c)
Preoperative X-ray. (d) The condition of thumb defect after debridement. (e) Preoperative design. (f) Dissociation of the ap. (g) The dissociated ap. (h) The palmar view of the reconstructed thumb after the
operation. (i) The dorsal view of the reconstructed thumb after the
operation. (j) X-ray after the operation. (k) The situation of the donor
site and recipient site 2 weeks after the operation. (l) Appearance contrast of the reconstructed thumb 8 months after the operation. (m) The
exor function of the reconstructed nger 8 months after the operation.
(n) The holding function of the reconstructed nger 8 months after the
operation. (o) The situation of the donor site 8 months after the
operation
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