FIG. 19-40. The double-muscle transplant resurfaced the skin-grafted skull. The original skin graft was meshed and replaced over the muscles.
FIG. 19-41. A lateral view of the scalp after placement of the latissimus and serratus. The transplants lend themselves well to folding over a spherical surface such as the skull.
FIG. 19-42. The pliable muscle covered with a skin graft has replaced the previous unstable cover.
A 20-year-old man caught his hand in a meat grinder.
FIG. 19-43. The wrist joint was open, and a 15 cm segment of the median nerve was avulsed. The little finger was ground off and not replantable.
FIG. 19-44. The wound was debrided in preparation for nerve grafting and flap cover, performed 72 hours after injury.
FIG. 19-45. The latissimus with a small skin island for monitoring was used to cover the massive defect.
FIG. 19-46. Three-month follow-up. The thumb has developed a sublexed MCP joint. The muscle has atrophied considerably.
FIG. 19-47. Reconstruction of the thumb with an opponensplasty has been combined with flap debulking and joint fusion. Side view.
FIG. 19-48. Volar view.
A 53-year-old welder caught his hand in a metal roller press with only 1/16 inch clearance.
FIG. 19-49. The hand was crushed and degloved to the level of the metacarpal joints. Dorsal view.
FIG. 19-50. Palmar view.
FIG. 19-51. The preoperative x ray shows the extent of bony injury.
FIG. 19-52. To provide both dorsal and volar coverage, a combined latissimus and serratus muscle flap was harvested.
FIG. 19-53. The ulnar aspect of the hand has required extensive debridement. Double-muscle transplant next to wound.
FIG. 19-54. The postoperative result shows completed coverage, preserving the metacarpal joints for later reconstruction with multiple toe transplants.