Dorsal Hand Coverage with Free Serratus Fascia Flap

Abstract

In reconstructing a defect on the dorsum of the hand, with the extensor tendons exposed or even missing, functional, as well as cosmetic, goals are of major importance. The authors present three cases of extensor tendon reconstruction, combined with soft-tissue reconstruction, with the free serratus fascia flap, the connective tissue over the serratus muscle, for dorsal hand coverage. The flap consists of thin and well-vascularized pliable tissue, with gliding properties excellent for covering exposed tendons. It is based on the branches of the thoracodorsal artery, which are raised in the flap, leaving the long thoracic nerve intact on the serratus muscle. Coverage of the flap with split-thickness skin graft is done immediately. The free serratus fascia flap is an ideal flap for dorsal hand coverage when the extensor tendons are exposed, especially because of low donor-site morbidity.

Reconstruction of Hand and Foot Defects with Free Serratus Carpaccio Flap and Free Serratus Fascia Flap: A Comparative Retrospective Study of Surgical Outcomes

“…In contrast, the temporoparietal fascia flap has a pedicle length of approximately 4 cm and a maximum flap size of 14 × 10 cm [28]. Overall, the serratus fascia flap is associated with low donor-site morbidity and functional deficits [29]. In a previous study, Flügel and colleagues performed free serratus fascia flaps for defect coverage of the hand in 11 cases [15].…”

Reconstruction of severe hand contractures: An illustrative series

“…[45] Local and regional flap choices include the dorsal ulnar flap for palmar defects up to the bases of the digits,[4] the posterior interosseus artery flap, which can be used as far as the MCPJs, or in a two-stage procedure to cover defects extending on to the fingers,[6] the reverse radial forearm flap,[7] the reverse ulnar forearm flap, radial artery perforator flap[7] and ulnar artery perforator flap. [8] Free flaps that have been recommended for use in reconstruction of the burnt hand include the medial plantar artery flap for palmar defects,[5] the anterolateral thigh perforator flap, either as a fasciocutaneous flap or adipofascial flap with skin graft,[9] the serratus fascia flap with split-thickness skin graft[10] and the temporoparietal fascial flap with split-thickness skin graft. [11]…”

“…This is recognized to improve the mobility of the hand because it reduces the occurrence of adhesions between the tendons and the skin. [910] Hence, the common factor in all the above flaps is the use of the fascial layer in this manner, whether as part of a fasciocutaneous flap or a fascial flap that is skin grafted.…”

“…The use of fascial flaps with split-skin grafts is a recognized option that is commonly used when free flaps are available with all the options that this releases. [10] Long-term follow-up is lacking and therefore it has not yet been determined whether the split-skin graft onto the fascial flap will contract to the extent that a split-skin graft on its own would. [11] There have been a couple of cases with follow-up over 3 years, neither of which have shown contracture formation, and it is hoped that the rapid graft take and good gliding provided by this method that facilitate early aggressive physiotherapy may help to prevent recurrent contracture formation.…”