FIG. 5-05

FIG. 5-06. A long proximal vascular pedicle is developed.

FIG. 5-07. Six-month follow-up shows good contour without breakdown. The donor site has been closed with skin grafts, and the patient has full weight bearing without pain. Posterior view.

FIG. 5-08. Plantar view.

FIG. 5-09. Medial view.

CASE 2

This patient sustained a deep electrical burn of the ulnar portion of the distal palm and proximal phalangeal joints of the ring, little, and long fingers.

FIG. 5-10. Previous attempts at release of the soft tissue flexion contracture with split-thickness skin grafts and full-thickness skin grafts have resulted in this deformity.

FIG. 5-11. From the opposite normal hand. Template is designed and brought down to the foot to outline the necessary flap from the first web space.

FIG. 5-12. This picture illustrates the deformity after contracture release. Note the exposed neurovascular bundle and flexor tendons. The contracture on the long finger was corrected with multiple z-plasties.

FIG. 5-13. The first web space flap is outlined. Note that the flap extends to the lateral side of the large toe and the medial side of the second toe. This flap is based on an extension of the dorsalis pedis artery, the superficial first metatarsal artery. Blood supply to this area through the superficial first metatarsal artery must be documented by Doppler or arteriogram preoperatively.

FIG. 5-14. The flap is mobilized proximally with nerve, artery, and vein within the pedicle.

FIG. 5-15. The flap is now placed next to the donor defect. Longitudinal pins are in place across the PIP and metacarpal phalangeal joints of the ring and little fingers to keep the fingers temporarily in an extended position.

FIG. 5-16. After microvascular anastomosis and microneural anastomosis, the wound is closed primarily.

FIG. 5-17. Flexion is shown.

FIG. 5-18. Several months postoperatively, excellent flexion and extension have been restored to this once severely compromised hand. Extension is shown.

CASE 3

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