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 FIG. 15-30. Late follow-up. The patient has solid union without pain. Front view.
 FIG. 15-31. Side view.
CASE 4
This patient had a through-and-through gunshot wound of the dorsum of the hand.
 FIG. 15-32. The wound is illustrated, with disruption of the base of the first, second, third, and part of the fourth metacarpals and half of the distal carpal row.
 FIG. 15-33. X ray shows the bony defect with a stainless steel wire and temporary spacer.
 FIG. 15-34. Appearance of the wound after debridement and conversion of the two dorsal wounds into a single wound. The extensor tendons are intact.
 FIG. 15-35. Outline of the proposed osteocutaneous groin flap with "X" marking the anterior superior iliac spine and pubic tubercle.
 FIG. 15-36. The osteocutaneous flap has been completely mobilized, with the superficial circumflex iliac system supplying the skin island and the deep circumflex iliac system supplying the underlying bone segment.
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 FIG. 15-37. The osteocutaneous flap has been transferred to a separate table, where the superficial circumflex iliac artery and vein are sutured to a branch of the deep system producing an internal shunt.
 FIG. 15-38. The bone block is pinned into the traumatic defect.
 FIG. 15-39. The deep circumflex iliac artery is sutured to the radial artery in an end-to-side fashion, preserving distal circulation to the hand. The vein is repaired to the cephalic vein using an interpositional vein graft to reach a good proximal vessel.
 FIG. 15-40. An x ray several months postinjury shows solid union of the bone block to the base of the metacarpals and the proximal carpal bones.
 FIG. 15-41. Lateral view shows wrist motion.
 FIG. 15-42. Good flexion and extension of the fingers with a stable wrist. Extension.
 FIG. 15-43. Flexion.
CASE 5
This is another case of a through-and-through gunshot wound of the hand.
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