title: The volar forearm fasciocutaneous extension: a strategy to maximize vascular outflow in post-burn injury hand transplantation.
abstract: Patients with circumferential extremity burns may have a deficiency of cutaneous veins, which presents a challenge for both autologous reconstruction and vascularized composite allotransplantation. The authors present a 44-year-old, left-hand-dominant man with metacarpal level amputation of his left hand secondary to burn injury. Extensive prior débridement and skin grafting resulted in nearly total absence of cutaneous veins in the forearm. The patient underwent unilateral left hand transplantation with an allograft designed to include a volar forearm fasciocutaneous extension supplied by the radial artery and including the basilic vein to permit augmented venous drainage by means of anastomosis at the antecubital fossa. The volar forearm fasciocutaneous extension can increase vessel caliber and possibly improve reliability in the setting of hand transplantation and should be considered following severe burn injury.
authors.affiliation: Boston, Mass. From the Division of Plastic Surgery, the Department of Orthopaedic Surgery, and the Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Eberlin
authors.forename: David A
authors.initials: DA
authors.lastname: Leonard
authors.forename: William G
authors.initials: WG
authors.lastname: Austen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Yaremchuk
authors.forename: Chaitanya S
authors.initials: CS
authors.lastname: Mudgal
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Winograd
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Cetrulo
mesh_terms: D000328:Adult; D002056:Burns / Q000150:complications / Q000601:surgery*; D005205:Fascia / Q000637:transplantation; D005542:Forearm / Q000601:surgery*; D006225:Hand / Q000098:blood supply*; D006230:Hand Injuries / Q000209:etiology / Q000601:surgery*; D063987:Hand Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D012039:Regional Blood Flow; D016038:Skin Transplantation