This case involved a groin dermofat graft to the right side of the face to correct a hemifacial macrostomia. (From Alpert, B.S., Gordon, L., and Buncke, H.J.; The groin. In Symposium on Clinical Frontiers in Reconstructive Microsurgery. Vol. 24. Edited by H.J. Buncke and D.W. Furnas, St. Louis, C.V. Mosby, 1984.)

FIG. 6-20. Marked atrophy, particularly in the malar nasolabial and outer commissure areas of the mouth because of hemifacial macrostomia.

FIG. 6-21. A groin dermofat graft was used as in the previous case.

CASE 5

This patient had reconstruction of the breast with a large groin flap after a modified mastectomy. One of the advantages of this type of breast reconstruction is that no additional scars are created on the posterior chest; expendable tissue on the lower abdomen is used. (From Gant, T., Serafin. D., and Buncke, H.J.: Free flap reconstruction of the breast. In Post-Mastectomy Reconstruction. Edited by T. Gant and L.O. Vasconez. Baltimore, Williams and Wilkins, 1981.)

FIG. 6-22. The preoperative defect shows the transverse scar.

FIG. 6-23

FIG. 6-24. The flap is inset. An implant is used to add bulk.

FIG. 6-25. Immediate postoperative result.

FIG. 6-26. Late result after nipple-sharing procedure.

CASE 6

A 16-year-old boy blew off both thumbs and the right index finger while trying to defuse a firecracker. The right hand, with a non-replantable thumb and index finger, was closed initially with a free serratus flap.

FIG. 6-27. Hand x rays of patient.

FIG. 6-28. Appearance of right hand wound.

FIG. 6-29. The index metacarpal was covered with a serratus muscle flap.

FIG. 6-30. The index metacarpal was pollicized and wrapped in a groin flap to provide sufficient soft tissue for a web space.

FIG. 6-31. Groin flap isolated.

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