[Plastic surgery of the thumb, using the epiploon. The problem of integrating mechanical hand prostheses into the body]

The techinque using epiloon tissue in hand surgery was introduced by the author in 1974. The efficiency of the method was checked in several cases of radionecrosis of the hand, deep burns with complete destruction of the tissues on the back of the hand, severe trauma with tearing of the teguments and uncovering of the bones. Epiploonoplasty of the hand achieves a massive transfer of thick epiplooic tissue which is well vascularized, rapidly integrated in the circulatory system of the hand. An extensive description of the surgical technique is presented. A case of severe trauma with amputation of the thumb and of three other fingers of the right hand is further described. The thumb was repaired with a fragment of rib covered with epiplooic tissue exteriorized from the abdominal cavity through laparotomy. The epiplooic pedicle was sectioned after 35 days, and grafting was continued with free dermo-epidermal flaps. The functional result obtained was excellent. The author also presents his experience with a hand prosthesis made of metal and acrylate, which, after being joined to the bones of the forearm and connected with flexor and extensor muscular groups, was completely covered with a thick layer of epiplooic tissue and grafted with skin. A mechanical hand can be achieved with the aid of epiploonoplasty.