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The fine balance of the hand mechanisms is so dependent upon the perfect functional inter-relationship of all its component parts that the damage to any one structure has an appreciable effect on the total hand action. A normal skin and subcutaneous covering is thus essential to good functional reconstruction.
A description of the operations carried out on the hand shown in the accompanying pictures depicts a typical glove flap replacement. The entire scar on the dorsum of the hand and fingers was excised. A surgical glove was placed on the hand and sutured along the denuded edges. The portion of the glove covering the defect was cut out, a pattern of the hand defect was made on the right side of the abdomen and the donor flap and seven pedicles, one for each finger; one for the ulnar and the radial side, was elevated by sharp dissection. The center flap and pedicles were made as thin as possible. The abdominal bed was skin grafted and then the injured hand was placed in the abdominal pocket and the flap pattern sutured to the hand. The digital pedicles were amputated in seven days, the ulnar pedicle in five days more, and the radial pedicle in one week more. The flaps were cut off under local anesthesia and sutured into their respective places and at the time of freeing from the abdominal wall complete take of the abdominal skin grafts was observed. The entire dorsum of hand and fingers was covered in nineteen days with a hospital stay of twenty-two days. By using elastic traction seven days after the last operation, a complete range of active finger motion was quickly obtained. At the present writing sensory nerve return has taken place.
The glove flap method is highly satisfactory for quick and effective dorsal hand coverage and the donor material so simulates the normal covering that unless irreparable deeper damage is done at the time of the original injury a maximum return of function and appearance can be expected.
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© 1936 Published by Elsevier Inc.