LETTERS TO THE EDITOR Split-thickness skin grafts for coverage of defects in the hand To the Editor: Supplementary to the excellent article of Robotti and Edstrom on the “Split-Thickness Plantar Skin Grafts for Coverage in the Hand and Digits” (J HAND SURG 1991;16A:143-6), it might be of interest to remark that we no longer regard the forearm a cosmetically acceptable donor site for skin grafts.’ This is not contradicted by Robotti and Edstrom, who mention the forearm as one of the traditionally used donor areas, but they indicate that the use of this sort of skin may lead to complications in the recipient site. However, since more and more patients seek our help for correction of the scars on the donor site we, unlike Zoltie,’ fully agree with the opinion that “grafts from the volar aspect of the forearm or antecubital fossa result in unjustifiable disfigurement and usually are only used for the convenience of the surgeon.“3 J.J. Hage, MD, and J.J.A.M. Bloem, MD, PhD Department of Plastic Surgery Academic Hospital Free University P.O. Box 7057 N-1007 MB Amsterdam. The Netherlands
We agree that when a donor site for a skin graft is chosen, the recipient site should not be the only consideration. The donor site itself may cause complications worse than the original problem, as in the case of the forearm, in which some very unattractive scars can be produced in a regrettably conspicuous area, after only the slightest delay in healing. Our inclusion of the forearm in the list of traditional donor sites was done only for completeness. Lee E. Edstrom. MD
Bilateral palmaris profundus causing bilateral carpal tunnel syndrome To the Editor: I read with interest the article by Doctors Floyd, et al. (J HAND SURG 1990;15A(2):364-6) regarding a case of bilateral palmaris profundus muscle. They concluded in their article that this muscle was the cause of the patients bilateral carpal tunnel syndrome. I have recently treated a patient for carpal tunnel syndrome who also had a palmaris profundus muscle. This muscle was enclosed within the investing tissue surrounding the median nerve and ran on its palmar ulnar side. The photograph shows the palmaris profundus muscle dissected free of the nerve and enclosed in a ligaloop.
REFERENCES Hage JJ, Bloem JJAM. The forearm, no longer a suitable donor area in skin defects of the hand. Ned Tijdschr Geneeskd 1991;135:174-7. Zoltie N. Forearm split-skin donor sites: are they cosmetically acceptable? Ann Plast Surg 1988;21:1 l-3. Beasley RW. Cosmetic considerations in surgery of the hand. In: Tubiana R, ed. The hand. Vol. II. Philadelphia: WB Saunders, 198596-103.
Reply We appreciate the opportunity to answer the letter from Drs. Hage and Bloem regarding our article, “SplitThickness Palmar Skin Graft for Coverage in the Hand and Digits. ” They point out that they “no longer regard the forearm as a cosmetically acceptable donor site for skin grafts,” correctly identifying the forearm as a donor site that is likely to produce complications.
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THEJOURNAL OF HANDSURGERY
Fig. 1. Constriction
of nerve in midcarpal tunnel region.
We agree that when a donor site for a skin graft is chosen, the recipient site should not be the only consideration. The donor site itself may cause complications worse than the original problem, as in the case of the forearm, in which some very unattractive scars can be produced in a regrettably conspicuous area, after only the slightest delay in healing. Our inclusion of the forearm in the list of traditional donor sites was done only for completeness. Lee E. Edstrom. MD
Bilateral palmaris profundus causing bilateral carpal tunnel syndrome To the Editor: I read with interest the article by Doctors Floyd, et al. (J HAND SURG 1990;15A(2):364-6) regarding a case of bilateral palmaris profundus muscle. They concluded in their article that this muscle was the cause of the patients bilateral carpal tunnel syndrome. I have recently treated a patient for carpal tunnel syndrome who also had a palmaris profundus muscle. This muscle was enclosed within the investing tissue surrounding the median nerve and ran on its palmar ulnar side. The photograph shows the palmaris profundus muscle dissected free of the nerve and enclosed in a ligaloop.
REFERENCES Hage JJ, Bloem JJAM. The forearm, no longer a suitable donor area in skin defects of the hand. Ned Tijdschr Geneeskd 1991;135:174-7. Zoltie N. Forearm split-skin donor sites: are they cosmetically acceptable? Ann Plast Surg 1988;21:1 l-3. Beasley RW. Cosmetic considerations in surgery of the hand. In: Tubiana R, ed. The hand. Vol. II. Philadelphia: WB Saunders, 198596-103.
Reply We appreciate the opportunity to answer the letter from Drs. Hage and Bloem regarding our article, “SplitThickness Palmar Skin Graft for Coverage in the Hand and Digits. ” They point out that they “no longer regard the forearm as a cosmetically acceptable donor site for skin grafts,” correctly identifying the forearm as a donor site that is likely to produce complications.
182
THEJOURNAL OF HANDSURGERY
Fig. 1. Constriction
of nerve in midcarpal tunnel region.
