case_images: PMC4075199_01
case_images: At presentation
case_images: IJPS-47-120-g001.jpg
case_images: PMC4075199_01_IJPS-47-120-g001.jpg
case_images: F1
case_images: 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].
case_images: At presentation
case_images: IJPS-47-120-g002.jpg
case_images: PMC4075199_01_IJPS-47-120-g002.jpg
case_images: F2
case_images: 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].
case_images: The palmar arch defect
case_images: IJPS-47-120-g003.jpg
case_images: PMC4075199_01_IJPS-47-120-g003.jpg
case_images: F3
case_images: 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].
case_images: The palmar arch defect illustrated
case_images: IJPS-47-120-g004.jpg
case_images: PMC4075199_01_IJPS-47-120-g004.jpg
case_images: F4
case_images: 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].
case_images: Dorsal venous arch exposed
case_images: IJPS-47-120-g005.jpg
case_images: PMC4075199_01_IJPS-47-120-g005.jpg
case_images: F5
case_images: T-shaped incision made and skin flaps raised to expose the venous arch [Figure 5].
case_images: Venous arc harvested
case_images: IJPS-47-120-g006.jpg
case_images: PMC4075199_01_IJPS-47-120-g006.jpg
case_images: F6
case_images: 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.
case_images: Anastomosis
case_images: IJPS-47-120-g007.jpg
case_images: PMC4075199_01_IJPS-47-120-g007.jpg
case_images: F7
case_images: Flow across all the anastomoses was confirmed [Figure 7].
case_images: Post-operative healing
case_images: IJPS-47-120-g008.jpg
case_images: PMC4075199_01_IJPS-47-120-g008.jpg
case_images: F8
case_images: Post-operative recovery was uneventful [Figures 8-10].
case_images: Post-operative recovery
case_images: IJPS-47-120-g009.jpg
case_images: PMC4075199_01_IJPS-47-120-g009.jpg
case_images: F9
case_images: Post-operative recovery was uneventful [Figures 8-10].
case_images: Post-operative recovery
case_images: IJPS-47-120-g010.jpg
case_images: PMC4075199_01_IJPS-47-120-g010.jpg
case_images: F10
case_images: Post-operative recovery was uneventful [Figures 8-10].