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AV fistulae are extremely rare complications after hand replantation. In the case presented, the formation of an AV fistula did not occur immediately after the replantation, but after the insertion of the free lateral arm flap to the extensor surface of the replanted hand. This paper discusses the mechanisms responsible for the formation of AV fistulae.

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Avulsion injuries of the thumb resulting in volar defects and loss of neurovascular bundles are presented. Treatment should aim at restoration of the skin and pulp with as near normal sensation as possible. A new technique is described using a cross-finger flap or flaps with transfer of the superficial terminal branch of the radial nerve. It is claimed that this gives near normal restoration of sensation to the tactile surface of the thumb. The fingers may be treated in the same way for similar injuries.