Free Flap Reconstruction of Traumatic Skin Defects of the Entire Hand Dorsum.

Background/

Objectives

The reconstruction of hand defects, especially involving the dorsal region of the hand, has remained a challenge for surgeons because of its anatomical features and complex functions. The goal of reconstruction should include functional restoration as well as being esthetically pleasing. The flap transfer reconstruction strategy is essential for satisfying these requirements.

Methods

Free flaps were used to cover traumatic defects of the hand dorsum in eleven patients from 2016 to 2022. Eight males and three females with a mean age of 41 years were enrolled. The size of the flaps ranged from 6 × 5 cm to 20 × 9 cm, and the selected flaps included five anterolateral thigh flaps, three lateral arm flaps, and three superficial circumflex iliac artery flaps.

Results

All flaps survived, with one case of partial necrosis. One patient experienced joint stiffness during recovery. The donor sites were closed primarily, and there was no need for skin grafting. Secondary debulking or thinning was also not required. The majority of cases recovered excellent function of the hand (mean Q_DASH: 2.5) with satisfactory esthetic outcomes. The postoperative observations were followed by more than six months.

Conclusions

Small defects can be treated using local, pedicled, and island-type flaps. However, larger defects involving the exposure of tendons, nerves, and other critical structures commonly require free tissue transfers. The flap reconstruction for hand dorsum in the study is feasible to produce acceptable outcomes in large sized defects.