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In treating skin-loss of the hand there are many factors to consider. Technical excellence of local repair is not enough if the patient and the whole limb are not treated properly.
Conservation of tissue is important and the more severe the injury the greater should be the attempt to retain tissue. Nevertheless the value of any tissue saved must be considered in terms of whole hand function.
Skin replacement should be the simplest which is effective. On a surface which will accept a skin-graft it is bad surgery to apply a flap, unless later repair is anticipated.
Primary closure of hand wounds is important, but maintenance of closure is more so. To achieve permanent closure it is often valuable to delay primary closure, whether finally using direct wound apposition, skin-grafting, or flaps.
Immobilization in the right position is an adjunct to healing and, provided it is limited in time and extent, it can only result in eventual advantage by promoting sound healing and secure closure.
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- A Two-stage Method for Pharyngoesophageal Reconstruction with a Primary Pectoral Skin Flap.Plastic reconstr. Surg. 1965; 36: 173
- War Wounds of the Hand in Viet Nam.Milit. Med. 1969; 134: 1
- The Crane Principle for the Transport of Subcutaneous Tissue.Plastic reconstr. Surg. 1969; 43: 451
© 1971 Published by Elsevier Inc.