Microsurgical Soft-Tissue Hand Reconstruction: An Algorithm for Selection of the Best Procedure

Abstract

Microsurgical hand reconstruction can be the first option to consider in some particular and complex clinical situations. An algorithm based on anatomical considerations and functional outcomes, may be useful for the plastic surgeon that deals with these challenging cases.

Primary tumors of the hand: Functional and restorative management

“…The free medial sural artery perforator flap may be used for small‐to‐medium sized hand defect reconstruction . This flap may be harvested with a segment of tendon or nerve graft for composite tissue reconstruction.…”

“…This flap can also include the lateral edge of the scapula. The temporal fascia free flap can be used for extensive dorsal hand defects, and has the advantages of being thin, well‐vascularized, and containing a reliable pedicle from the superficial temporal vessels . This flap can include the outer table of the frontoparietal calvarium.…”

“…Another option for extensive dorsal hand defects is the dorsalis pedis composite free flap, based on dorsalis pedis‐first dorsal metatarsal vascular axis. It can be compounded as an osteocutaneous flap with the second metatarsal or the metatarsophalangeal joint . Its ability to contain bone, joint, and tendon is useful in the reconstruction of composite hand defects …”

“…If tendons are spared resection but exposed by surgery, free fasciocutaneous flaps, such as the radial forearm, anterolateral thigh (ALT), lateral arm, scapular, parascapular, or thoracodorsal perforator flap, can provide a gliding surface for tendon sheaths . The temporal fascia free flap can be utilized for multidigit coverage by contouring into bony concavities and provide a gliding apparatus for denuded tendons . Contralateral antebrachial radial free flaps incorporating the palmaris longus tendon can be used for extensor tendon reconstruction in cases of large‐scale loss requiring tendon sacrifice or exposure .…”

“…The temporal fascia free flap can be utilized for multidigit coverage by contouring into bony concavities and provide a gliding apparatus for denuded tendons . Contralateral antebrachial radial free flaps incorporating the palmaris longus tendon can be used for extensor tendon reconstruction in cases of large‐scale loss requiring tendon sacrifice or exposure . The palmaris longus tendon can also be grafted to reconstruct the flexor carpi ulnaris …”