La chirurgie plastique ; ses principes et pratiques . cei sont unis et solidaires du tendon extenseur du doigt(nouveau) pouce. (E) Le nerf cutané radial exposés dans la première étape de l'theoperation est suturé à la branche collatérale du nerf médian de thering doigt. (/) Les incisions cutanées sont suturées. L'incision sur le radialborder du poignet est suturé dans une direction distale pour couvrir le basethe nouveau métacarpe et le tendon syndicats. La nageoire dorsale et de LA CHIRURGIE DES EXTRÉMITÉS 683 palmar bords de l'incision sur la frontière radial de la main aresutured à la nageoire dorsale et palmaire bords

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Plastic surgery; its principles and practice . cis are united and joined to the extensor tendon of the finger(new thumb). (e) The radial cutaneous nerve exposed in the first stage of theoperation is sutured to the collateral branch of the median nerve of thering finger. (/) The skin incisions are sutured. The incision on the radialborder of the wrist is sutured in a distal direction to cover the basethe new metacarpal bone and the tendon unions. The dorsal and SURGERY OF THE EXTREMITIES 683 palmar edges of the incision on the radial border of the hand aresutured to the dorsal and palmar edges of the skin bordering the tri-angular raw area on the radial border of the ring finger (new thumb).Fine interrupted catgut sutures are used throughout for the skinstitches. The hands are then fixed in the apposed position with plaster ofParis, which is left undisturbed for four weeks, and is then removed. (4) The final stage in the operation consists in dividing the nutritiveflap (two months later) and separation of the hands, ligature of the. Fig. 809.— {Joyces case, continued.)—A-ray after transplantation. proximal ends of the ulnar digital vessels of the finger which has beenremoved, and closure of the raw areas which remain. I have not yet had an opportunity to try this method, but it isundoubtedly rational, and ought to be a satisfactory procedure. Toes have been transplanted (Nicolodini, Krause. Klemm, Eisels-berg, Horhammer and others) to take the place of a missing thumb orfinger, but the result is seldom worth the trouble. The bone of a lost phalanx may be replaced by a shaped piece ofrib cartilage (Morestin, Soubey-^in and Perret). or by a phalanx from 684 PLASTIC SURGERY the toe (Wolf, Goebel and others), or by a free bone graft from the tibiaor ribs (Morestin and others). TENDON INVOLVEMENT If tendons of either extremity are involved in addition to the skin, and are tightly adherent to the scar and underlying tissue, they shouldbe carefully freed, and the fat of

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