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Functional Assessment of Transplanted Skin in Volar Defects of the Digits A COMPARISON BETWEEN FREE GRAFTS AND FLAPS
RICHARD W. PORTER
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From the Plastic and Jaw Department, Royal Hospital Annexe, Sheffield, England
1968 by The Journal of Bone and Joint Surgery, Incorporated
The Journal of Bone & Joint Surgery.  1968; 50:955-963 
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Abstract

1. One hundred grafts or flaps applied to volar digital defects were examined with special reference to their sensory and autonomic reinnervation.

2. Sensation was better in cross-finger flaps and thenar flaps, and they gave an excellent cosmetic result. Their donor sites were not without minor complications,

[See figure in the PDF file]

but these could be overcome in thenar flaps. Wolfe grafts were not as satisfactory but were an improvement on splint-skin grafts, which tend to be poorly innervated and to give a bad cosmetic result. Pectoral flaps were poorly innervated, probably because they were used to cover large defects and not because of any inherent quality in the donor skin.

3. It is suggested that for any given area of defect the thicker the donor skin the better the functional result and that for a given thickness of skin the sensation decreases with increased size.

4. Response to adrenaline showed that autonomic reinnervation was complete at two years, after which the sweating of pedicle flaps was related to recovery of sensation.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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