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![The mangled upper extremity: a principled approach to management](https://image.oaes.cc/dddaee1b-7870-4386-8041-1be20d209a87/par11099.fig.4.jpg)
Figure 4. (A, B) A complex circumferential degloving injury with gross contamination after a motor vehicle collision; (C) An external fixator was placed to stabilize the carpus and the volar soft tissue deficit was reconstructed with a pedicled groin flap; (D) The dorsal soft tissue deficit was addressed with placement of a dermal regeneration matrix; (E, F) 3 weeks later, the groin flap was divided and inset, and split-thickness skin grafting was performed on the dorsum of the hand.