Injury
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Since the advent of the operating microscope by Julius Jacobson in 1960, reconstructive microsurgery has become an integral part of extremity reconstruction and orthopaedics. During World War I, with the influx of severe extremity trauma Harold Gillies introduced the concept of the reconstructive ladder for wound closure. ⋯ We now have a microsurgical reconstructive ladder. The microsurgical reconstruction ladder is based upon the early work on revascularization and replantation extending through the procedures that are described in this article.
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Multiple digital losses will result in crippled hand function and toe transfers are proven to provide replacement of prehensile function. Given that basic hand function requires three factors, viz. an ulnar component, a radial component and opposition, various toe transfers can accomplish thumb ray and ulnar digital defect restoration. Opponensplasty and interpositional suspension arthroplasty can provide circumduction to the thumb component required to perform prehensile functions.