|| FIG. 31-74. Early postoperative result. Long sural nerve grafts were used to restore the ulnar and median nerves.
FIG. 31-75. A functional gracilis muscle was transplanted to restore finger flexion. Skin graft placed on muscle. The anterior interosseous nerve was anastomosed to the motor nerve of the gracilis.
FIG. 31-76. Functional pinch and grasp have been restored.
FIG. 31-77. Tying shoes.
A 9-year-old child suffered a complete hand amputation in a motor vehicle accident through the radiocarpal joint.
FIG. 31-78. Amputated hand.
FIG. 31-79. The hand is replanted with longitudinal pins into the radius and ulna.
FIG. 31-80. Postoperatively, note dorsal compartment release incisions.
FIG. 31-81. Follow-up shows early return of median motor function to the thumb.
FIG. 31-82. Pinch.
FIG. 31-83. Improved function with late follow-up. Extension.
An 8-year-old boy suffered a near-complete crushing arm amputation.
FIG. 31-84. Dorsal view.
FIG. 31-85. The anterior view shows the widespread injury. A silicone tube shunt was immediately placed in the brachial artery to restore circulation. After bone stabilization, the vascular injuries were bridged with autogenous vein grafts. The extensive soft tissue defect required vascularized cover.
FIG. 31-86. A latissimus dorsi myocutaneous flap was isolated on its pedicle, with division of both insertion and origin.
FIG. 31-87. The flap was rotated to cross the elbow to provide wound closure and motor power for elbow and finger flexion.
FIG. 31-88. Late follow-up shows full range of shoulder motion, elbow extension, and finger extension.
FIG. 31-89. Pinch.
FIG. 31-90. Elbow flexion and grasp.