![A438101_1_En_18_Figb_HTML.gif](/wp-content/uploads/2017/11/A438101_1_En_18_Figb_HTML.gif)
After thorough debridement, the skin from the amputated part is used for cover and closure creating a useful esthetic four-finger hand.
![A438101_1_En_18_Figc_HTML.gif](/wp-content/uploads/2017/11/A438101_1_En_18_Figc_HTML.gif)
![A438101_1_En_18_Figc_HTML.gif](/wp-content/uploads/2017/11/A438101_1_En_18_Figc_HTML.gif)
18.3 Case 2
Arm gunshot injury to ulnar nerve with gap of 8 cm.
![A438101_1_En_18_Figd_HTML.gif](/wp-content/uploads/2017/11/A438101_1_En_18_Figd_HTML.gif)
![A438101_1_En_18_Figd_HTML.gif](/wp-content/uploads/2017/11/A438101_1_En_18_Figd_HTML.gif)
The gap was bridged by nerve allograft.
![A438101_1_En_18_Fige_HTML.gif](/wp-content/uploads/2017/11/A438101_1_En_18_Fige_HTML.gif)
![A438101_1_En_18_Fige_HTML.gif](/wp-content/uploads/2017/11/A438101_1_En_18_Fige_HTML.gif)
18.4 Case 3
A child referred after initial treatment for a right forearm amputation and injury to the left hand with severe adduction contracture.
![A438101_1_En_18_Figf_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figf_HTML.jpg)
![A438101_1_En_18_Figg_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figg_HTML.jpg)
![A438101_1_En_18_Figf_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figf_HTML.jpg)
![A438101_1_En_18_Figg_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figg_HTML.jpg)
Right forearm got a useful prosthesis.
![A438101_1_En_18_Figh_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figh_HTML.jpg)
![A438101_1_En_18_Figh_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figh_HTML.jpg)
Left hand’s first web space opened by gradual elongation of external fixation between the first and second metacarpal bones.
![A438101_1_En_18_Figi_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figi_HTML.jpg)
![A438101_1_En_18_Figj_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figj_HTML.jpg)
![A438101_1_En_18_Figi_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figi_HTML.jpg)
![A438101_1_En_18_Figj_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figj_HTML.jpg)
Good abduction was achieved with subluxation of the first carpometacarpal joint. The external fixation was replaced by plaster cast allowing spontaneous relocation of the joint.
![A438101_1_En_18_Figk_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figk_HTML.jpg)
![A438101_1_En_18_Figl_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figl_HTML.jpg)
![A438101_1_En_18_Figk_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figk_HTML.jpg)
![A438101_1_En_18_Figl_HTML.jpg](/wp-content/uploads/2017/11/A438101_1_En_18_Figl_HTML.jpg)
Cast removal followed by intensive guided exercises.
18.5 Case 4
Comminuted displaced fracture of the medial condyle of the elbow by blast injury.