FIG. 8-15. Lateral arm flap and donor site.
FIG. 8-16. Scar release with full finger extension produces a 5 x 14 cm defect.
FIG. 8-17. The inset flap improves coverage over the thenar base and expands the web space.
FIG. 8-18. An external fixator has been applied to maintain the web space distance during recovery. IP joint motion is not restricted.
FIG. 8-19. Final result. Extension, thumb abduction.
FIG. 8-20. Flexion.
A crush injury required toe amputation. The amputation was complicated by infection and exposed bone.
FIG. 8-21. Crush injury to the forefoot with loss of all toes and exposed metatarsal stumps.
FIG. 8-22. Arm flap mobilized down to vascular pedicle. Note Esmarch bandage used for hemostasis.
FIG. 8-23. Flap next to recipient defect. Dorsalis pedis vessels and deep peroneal nerve have been isolated for the microvascular hook-up.
FIG. 8-24. Flap in place. The flap nerve was anastomosed to the deep peroneal running with the recipient vessels.
FIG. 8-25. Late follow-up shows a closed wound with stable bony coverage.
A 24-year-old man suffered a severe crushing injury resulting in loss of the ulnar half of his hand.
FIG. 8-26. Constant pain from the unstable scar rendered the patient's hand useless.
FIG. 8-27. Preoperative flap marking is centered over the lateral epicondyledeltoid insertion axis.
FIG. 8-28. Dissection of the recipient site revealed two prominent neuromas of the ulnar and the median nerves to the second, third, and fourth web spaces.
FIG. 8-29. The flap inset, with microvascular anastomoses to the ulnar artery and veins. The ulnar neuroma was buried into the distal ulnar bone. A portion of the median neuroma was resected and the proximal end anastomosed to the sensory nerve to the flap.