Salvaging the Digit in Invasive Subungual Malignancies Using a Triple Technique under Awake Local Anesthesia

Figure 1

Intraoperative images showing the first stage of the Brunelli flap. Intraoperative image showing (a) marking of the Brunelli flap and the dorsoulnar artery perioperatively, as well as the palmar connection between the dorsoulnar artery and the palmar ulnar digital artery at the level of the interphalangeal joint of the thumb. (b) The skin paddle is incised deep till the paratenon of the extensor pollicis longus on its radial edge is reached and deep to the fascia covering the first dorsal interosseous muscle on its ulnar edge. (c) Rotation of the flap just proximal to the interphalangeal joint, followed by insertion and suturing in place.

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