The Journal of hand surgery
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From July 1, 1978, to July 1, 1980, 26 patients required pedicle flap coverage for acute skin loss defects in the hand and upper extremity. Eighteen patients had groin or abdominal flap coverage, and the pectoralis major island flap (PMIF) was used in eight patients. The circumstances of injury were approximately the same in both groups, consisting of a gunshot wound or electrical injury in over half of the cases. ⋯ Two of 13 groin flaps sustained partial necrosis, but none of the abdominal or PMIF flaps necrosed. The principle advantages of the PMIF in these selected cases was fourfold: (1) an extremity placed in a less dependent, sling-like position, (2) mobility, (3) reliability, and (4) a complete inset into the defect. The chest wall donor site defect, however, must be given some consideration.
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The surgical treatment of 50 patients with 101 neuromas over the last 10 years is reported. Simple excision and implantation into local muscle resulted in an unacceptable reoperative rate of 65%. ⋯ There appears to be a correlation between delayed healing after the initial injury and the severity of neuroma symptoms. Dorsal translocation of the neuroma consistently resulted in decreased sensitivity without longterm recurrence.