PMC4075199_01
At presentation
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F1
The present case report is about a 14-year boy who met with a road traffic accident in which a metal bar impaction across the palm through first web resulted in avulsion the thumb and palmar soft-tissues [Figures 1 and 2].
At presentation
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F2
The present case report is about a 14-year boy who met with a road traffic accident in which a metal bar impaction across the palm through first web resulted in avulsion the thumb and palmar soft-tissues [Figures 1 and 2].
The palmar arch defect
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F3
On exploration under anaesthesia, it was found that the palmar arches were crushed and torn away from the ulnar and radial arteries proximally and the common digital arteries and princes pollicis distally [Figures 3 and 4].
The palmar arch defect illustrated
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F4
On exploration under anaesthesia, it was found that the palmar arches were crushed and torn away from the ulnar and radial arteries proximally and the common digital arteries and princes pollicis distally [Figures 3 and 4].
Dorsal venous arch exposed
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F5
T-shaped incision made and skin flaps raised to expose the venous arch [Figure 5].
Venous arc harvested
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F6
The same was carefully dissected and harvested including sufficient length of the proximal extensions of the arch, the tributaries from the web spaces and a longer tributary from the medial aspect of the great toe [Figure 6]. The donor site was closed primarily.
Anastomosis
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F7
Flow across all the anastomoses was confirmed [Figure 7].
Post-operative healing
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F8
Post-operative recovery was uneventful [Figures 8-10].
Post-operative recovery
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F9
Post-operative recovery was uneventful [Figures 8-10].
Post-operative recovery
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F10
Post-operative recovery was uneventful [Figures 8-10].