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To assess the effective distribution of blood supply in jejunal graft with the 3rd intestinal artery as pedicle and to afford a reliable theoretic base for clinical esophageal reconstruction. Thirty-two formalin-preserved and 21 fresh cadaver specimens were studied with anatomic measurement, acetic ester perfusion, and Acrylonitrile butadiene styrene (ABS) vascular casting specimen. Results demonstrate there is no significant variation of vascular in the two groups. The inner diameter of the 3rd intestinal artery is comparatively larger among five intestinal arteries. There is a wider distribution of efficient blood supply in the 3rd intestinal artery. The mean (SD) length of homogenously stained jejunum segment, and the mean (SD) ABS effective distributing length of extended arches are 142.2 (62.3) cm and 30.8 (7.3) cm, respectively. The 3rd intestinal artery as pedicle can afford adequate blood supply to the jejunum segment and has effective arterial arch with enough length; thus it meets the need of esophageal reconstruction.

A new concept of esthetic reconstruction for partial loss of distal finger segment was introduced. In a series of 77 patients, 80 thumb or finger partial defects of lateral, dorsal, or volar half, or composite tissue defect of the finger body were reconstructed with lateral skin-nail flap, dorsal skin-nail flap, pulp flap, or composite tissue transplant taken from corresponding part of the toes. The blood circulations were reestablished by anastomosing digit arteries of the toe transplants and fingers. Seventy-eight fingers in 75 patients of this series were successfully reconstructed. The overall survival rate was 97.5%. Follow-up examinations made half to 12 years postoperatively showed normal length, outward appearance, and function of the reconstructed digits. Their nails are preserved or reconstructed. The pulps are full. Sweating is present. 2-PD was 4-6 mm. Esthetic reconstruction can achieve the goal of mending any part of tissue loss precisely with good result.

Twenty-six children aged from 14 months to 12 years had a total of 44 amputated digits replanted in our hospital between May 1979 and May 1985. The length of follow-up was from 9 to 15 years (average, 11 years). Among the 43 surviving digits, the mean total active motion of the thumb and fingers was 130 degrees and 151 degrees, respectively. Sensibility recovery was excellent, with normal 2-point discrimination in 88%. A mean of 19 of 20 preselected activities of daily living could be accomplished. Relative grip strength was 79% that of the normal side and the relative pinch strength was 88%. Cold intolerance was slight or moderate in 40% of patients, and slight atrophy was present in 12 digits. Angulatory deformity or malalignment were remodeled. The circulatory status of the replanted fingers was excellent in 88% of digits and good in 12%. Bone growth had a mean relative length of 93% of normal in digits without joint involvement and 88% in those with joint involvement. Assessed with Nakamura Tamai criteria, the results were excellent in 25 cases (96%) and good in 1. All patients and their parents were satisfied with the results of the digital replantation.

Three cases of mutilating injury of the distal end of the forearm, wrist, and palm treated by transplantation of severed digits to the forearm stump are reported. Follow-up examinations made at 1 year and 4 months to 31/2 years postoperatively revealed fair sensory and motor functions. The functional result is better than that obtained after Krukenberg's operation or prosthesis fitting, and is comparable to that of "hand" reconstruction by autotransplantation of toes. Since this procedure can fulfill the basic requirements of hand function by reconstruction, namely, good sensibility; basic motor functions of pinching, grasping, and powerful gripping; and acceptable outward appearance, and can be accomplished in a one-stage operation without sacrificing toes, it should be considered as first choice whenever a suitable case is encountered.

Sixty-four digits amputated at or distal to the distal interphalangeal joint were reimplanted in 57 patients with the use of microsurgical techniques. Five patients were children under 3 years of age. The percentage of survival was 96.9%. Before the operation, the surgical anatomy of the amputated digits was studied and particular attention was focused on the microvasculature. Equal emphasis was given to the reinnervation and revascularization of the amputated digits.

This article reports a series of 21 cases of digital replantation in children between 14 months and 10 years of age (mean age, 3 1/2 years) who had a total of 32 digits traumatically amputated. The amputation levels were proximal phalanx in 15 digits, proximal interphalangeal joint in 3 digits, middle phalanx in 3 digits, and distal interphalangeal joint in 11 digits. All but one digit survived after replantation, for an overall survival rate of 96.6%. The longest ischemic time was 28 hours. Several technical points related to the success of this series of cases are discussed in detail.

Since 1978 a series of 15 avulsively amputated thumbs were replanted with survival of the replantation in 14 patients. Good restoration of sensory and motor functions for these patients eradicates the old concept that replantation for avulsively amputated digits is contraindicated or a poor risk. We emphasize the importance of proper management of the transfer technique of the severed tendons, nerves, and blood vessels during the replantation. Details are described. The only failure was a result of technical faults. We conclude that replantation of an avulsively amputated thumb is worthwhile and will be beneficial to the patient.