FIG. 8-30

CASE 6

A plastic surgical resident lost four fingers in a building collapse during an earthquake in Mexico City.

FIG. 8-31. A classical groin flap was used to close the initial wound. Later, a double toe transplant was performed to provide three finger "chuck-pinch."

FIG. 8-32. There was residual, painful scarring over the hypothenar area.

FIG. 8-33. A lateral arm flap was used to provide durable coverage over the ulnar base of the hand and expand the web space. (See Case 2, Chapter 28) Recipient area prepared.

FIG. 8-34. Final result. The flap sensory nerve was repaired to the dorsal ulnar sensory to provide protective sensation in this critical area.

CASE 7

A 67-year-old man was treated with radiation therapy after resection of a mandibular squamous tumor.

FIG. 8-35

FIG. 8-36. Wide debridement resulted in a soft tissue defect that included the floor of the mouth and the chin.

FIG. 8-37. A lateral arm flap was transected across its middle, using one paddle for the oral surface and the other paddle, folded, for the cutaneous surface.

FIG. 8-38. Late follow-up shows closure of the fistula, adequate skin cover, and lining. Mandibular nonunion went on to solid fusion.

FIG. 8-39. Intraoral view shows lining pad of the folded lateral arm flap.

References

1. Katsaros, J., Schusterman, M., Beppu, M., Banis, et al.: The lateral upper arm flap: Anatomy and clinical applications. Ann. Plast. Surg. 12:489-500, 1984.

2. Song, R.: One stage reconstructions. Clin. Plast. Surg. 9:1, 1982.

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