FIG. 21-43. Chronically infected wound.

FIG. 21-44. The chronic granulation tissue is debrided to bare tendon.

FIG. 21-45. Follow-up at 10 months shows a closed wound after serratus transplantation.

CASE 9

The serratus is used for closure of a palmar wound following release of a postfasciotomy contracture and tenolysis.

FIG. 21-46. Palmar wound.

FIG. 21-47. An external fixator has been applied to maximize the breadth of the first web space, into which the end of the muscle was inserted.

FIG. 21-48. Broadening of the palm with a solid, glabrous flap has improved broad grasp.

CASE 1O

A 25-year-old construction worker suffered a crushing injury to his dominant hand in a cement mixer. Volar and dorsal coverage were required.

FIG. 21-49. Dorsal view.

FIG. 21-50. Palmar view.

FIG. 21-51. A free-serratus transplant has been split to provide both dorsal and volar closure, with anastomosis to the dorsal radial vessels.

FIG. 21-52. Early postoperative view with complete closure of both surfaces. Palmer view.

FIG. 21-53. Dorsal view.

FIG. 21-54. Hand function was improved by ray amputation of the stiff index finger. Palmar view.

CASE 11

A crush injury in a 21-year-old man was reconstructed primarily with a free gracilis flap.

FIG. 21-55. Osteomyelitis of the devascularized proximal phalanx of the thumb developed.

FIG. 21-56. Broad debridement of the wound, with reflection of the previous gracilis flap. The pointer is in the proximal bony metacarpal stump, which was also infected.

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