FIG. 6-32

FIG. 6-33. Subsequent great toe transplant to pollicized index metacarpal. Extension.

FIG. 6-34. Flexion. Case courtesy of Dr. Bernard Alpert.

FIG. 6-35. X rays of compound multiple transplants.

FIG. 6-36. The extent of the split-thickness skin graft cover over the bony structures.

CASE 7

A grinding avulsive injury of the dorsum of the hand and wrist has destroyed all structures down to the bone. Primary wound closure was achieved with a split-thickness graft. Flap cover is needed so that secondary extensor tendon grafts can be inset into the thumb, index, and long fingers. (From Buncke, H.J., and Harris, G.D.: Skin cover for challenging hand injuries. In Difficult Problems in Hand Surgery. Edited by J.W. Strickland and J.B. Steichen. St. Louis, C.V. Mosby, 1982.)

FIG. 6-36A. The size of the defect after removal of the split-thickness skin graft. (From Buncke, H.J., and Harris, G.D.: Skin cover for challenging hand injuries. In Difficult Problems in Hand Surgery. Edited by J.W. Strickland and J.B. Steichen. St. Louis, C.V. Mosby, 1982.)

FIG. 6-37. A customized groin flap has been elevated and sutured into place.

FIG. 6-38. Flap inset. Most groin flaps are bulky and become more so if the patient gains weight.

FIG. 6-39. The appearance of the groin flap after a secondary debulking procedure and extensor tendon grafts.

CASE 8

This case concerned a burn-scar contracture in a child. (From Alpert, B.S., Gordon, L., and Buncke, H.J.: The groin. In Symposium on Clinical Frontiers in Reconstructive Microsurgery. Vol. 24. Edited by H.J. Buncke and D.W. Furnas, St. Louis, C.V. Mosby, 1984.)

FIG. 6-40. Severe burn-scar contracture of the palm and fingers.

FIG. 6-41. Resertion of the palmar scar, allowing the fingers to extend fully, resulting in a 4 x 7 cm defect.

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