Reconstructing Dorsal Hand Defects Using the Distally Based Subcutaneous Perforator Fascia Flap Harvested Through Small Incisions.

OBJECTIVE

To describe reconstructing dorsal hand defects using the distally based subcutaneous perforator fascia flap harvested through small incisions.

METHODS

From January 2019 to May 2023, the dorsal hand defects were reconstructed with the fascia flap with the aid of loupes and headlights or arthroscopes. At the final follow-up, scars at the donor and recipient sites were assessed using the Scar Cosmesis Assessment and Rating scale.

RESULTS

This series included 16 patients (16 hands). There were 14 male and 2 female patients. The mean defect size was 6.8 cm × 5 cm (range, 5.6 cm × 6.4 cm - 9.1 cm × 5.3 cm). The mean flap size was 8.3 cm × 6.3 cm (range, 7 cm × 5.1 cm - 10.2 cm × 6.8 cm). The mean follow-up period was 32 months (range, 24-60 months). The mean pedicle length was 6 cm (range, 4-7 cm). All fascia flaps and skin grafts survived. At the final follow-up, the mean scar quality of the recipient site and skin over the donor site were 2 (range, 1-3) and 3 (range, 2-4), respectively, based on the Scar Cosmesis Assessment and Rating scale.

CONCLUSIONS

The distally based subcutaneous perforator fascia flap is reliable for reconstructing the dorsal hand defects, avoiding scar formation at the donor site. Loupes and headlights are more helpful than arthroscopes in fascia flap transfer.

LEVEL OF EVIDENCE: Therapeutic study, Level IVa.