William Stokes (1804--1878).
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Biomedical subjects
Publications and source records attributed to B O'Brien.
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Reconstruction of a severely damaged hand, with multiple amputations of digits, presents a difficult reconstructive problem. The development of a safe method of transfer of the great toe for thumb reconstruction, using the dorsalis pedis artery and the saphenous vein, suggested the possibility of one-stage microvascular transfer of the second toe for reconstruction of fingers. In two patients a one-stage transfer of the second toe was done to replace an index finger and in another for restoration of part of the left ring finger. The transplants survived without anticoagulants and vessel complications were not encountered. Sensory return was adequate and a significant improvement in function was achieved.
The neurovascular free flap from the first web region of the foot affords unrivalled potential for refurbishing sensibility to the denervated hand. Its greatest application is when no conventional island flap tissue remains for transfer. Its two-point discrimination is only moderate, but when used for thumb reconstruction, its sensibility is adequate because no functional substitute exists. Functionally and cosmetically it is superior to other methods of thumb reconstruction because of its pulp, size, and nail availability. There are no finger identification problems and secondary donor defects are minimal.
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