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 FIG. 20-28. Appearance of wound.
 FIG. 20-29. Debridement was done, leaving the hardware intact.
 FIG. 20-30. An ipsilateral rectus was designed.
 FIG. 20-31. Muscle mobilized on its deep pedicle.
 FIG. 20-32. Muscle transplanted to wound covering exposed metal. An end-to-side anastomosis to the anterior tibial artery was done.
 FIG. 20-33. The long-term result. Such wounds with exposed hardware can be closed, preserving the metal, if treated early and aggressively with thorough debridement and specific IV antibiotic cover.
CASE 5
A 13-year-old girl began developing localized Romberg's disease affecting the right nasolabial fold 3 years before admission.
 FIG. 20-34. The disease appeared to be stable for 1 year. Front view.
 FIG. 20-35. Side view.
 FIG. 20-36. Area needing "filling" is outlined.
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 FIG. 20-37. A small segment of rectus was harvested through a transverse incision in the "bikini" line. Such donor scars are greatly appreciated by all patients.
 FIG. 20-38. Segment of lower rectus mobilized on deep inferior epigastric vessels.
 FIG. 20-39. Muscle overlying cheek defect. The graft was inserted through an infraorbital incision and the pedicle tunneled to the inframandibular area for repair to the anterior facial vessels.
 FIG. 20-40. Final result. Overcorrection settled in about a year. The access scars are acceptable. Front view.
 FIG. 20-41. Side view.
CASE 6
A 33-year-old woman was shot in the hand at close range with a 38 pistol.
 FIG. 20-42. Dorsal view.
 FIG. 20-43. Side view.
 FIG. 20-44. Palmar view.
 FIG. 20-45. X ray showing defect of second, third, and fourth metacarpals
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