|| FIG. 6-42. A groin flap has been inserted into the first web space and across the palm. The vascular supply was anastomosed to the dorsal radial system. Sensation was provided by anastomosing T-12 to the dorsal ulnar sensory nerve. This child developed a useful hand.
In 1978, a young woman suffered a grade III-C tibial fracture in a car accident.
FIG. 6-43. Tibial fracture.
FIG. 6-44. After debridement, the fracture was covered successfully with rotation of the medial gastrocnemius musculocutaneous flap.
FIG. 6-45. The patient, unfortunately, was very unhappy with the contour defect left by closing the donor site with skin grafts.
FIG. 6-46. A large groin flap was harvested, the skin grafts excised.
FIG. 6-47. The groin flap filled the M-C defect nicely. The superficial epigastric vessels were anastomosed to the anterior tibial artery and vein.
FIG. 6-48. Late follow-up shows improved contour. Ankle motion has additionally improved after release of scar along Achilles tendon left by the M-C donor graft. The groin flap was closed primarily.
This patient had extensive burn-scar contractures of both upper extremities.
FIG. 6-49. The patient has an unstable scar and fixed elbow contracture on the right side and loss of all fingers on the left hand.
FIG. 6-50. The excisionsal defect of the scar about the elbow, with the groin flap next to the defect.
FIG. 6-51. The groin flap has been wrapped circumferentially about the elbow to provide protective cover and permit release of the scar-tissue contractures and joint contractures.
FIG. 6-52. Improved extension of the previously fixed elbow.
FIG. 6-53. The patient can now reach his face with his right hand, which he was unable to do before.
FIG. 6-54. The patient holds a coffee cup with his mobilized right hand and elbow and the saucer with a transplanted great toe and second toe on his left hand.