By John C. Kelleher
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Additional info for Abdominal Pedicle Flaps To The Hand & Forearm
Next Chapter Ten: UNUSUAL FLAPS AND COMPLEX RECONSTRUCTIONS Case No. 2: An 18-year-old female suffered a punch press injury to her left hand. She suffered significant degloving of the skin of the thumb as well as they severely crushed index finger and complete absence of the metacarpal III presumably lost by the mechanism of the injury. There was also severe degloving of much of the palm as well as the dorsal surface of the hand. Stage I. 2A, B). 2B A large abdominal flap based inferiorly was designed to cover both the dorsal and volar areas of skin loss.
1C). Today I would use clear plastic sheeting. The W's of the flap are designed to match those on the recipient site exactly. The flap measured 18 cm by 15 cm and the stem included both superficial inferior epigastric vessels. 1D). A heavy Kirschner wire was used to hold the forearm in neutral position and as suspension for the flap. E). This portion of the flap was left thick and not defatted. 1E Stage II. Three weeks later thought abdominal flap was detached and inserted along the all or border of the hand and forearm with W' s and small drains were inserted.
3B,C, D). 3D The flap was based on the superficial inferior epigastric vessels and measured 15 cm long by 6 cm in width. The fat tissue deep to Scarpa's fascia was excised. Scarpa's fashion was then elevated on a plane keeping the stem of the fascial flap intact. The skin superficial to Scarpa's fashion was then thinned down to the subdermal plexus. 3E, F). 3G). 3I next Chapter Ten: UNUSUAL FLAPS AND COMPLEX RECONSTRUCTIONS A thin flap for reconstruction of the palm: A flap for the palm must be thin to be effective.