Resurfacing Glabrous Skin Defects in the Hand

Abstract

Defects of the glabrous skin surfaces of the palm and fingers result from numerous causes including larger fingertip injuries, unhealed burns, and after surgery for diverse pathologies. The qualities of glabrous skin are specifically tailored to the functional requirements of high-shear strength and robustness. Despite these unique properties, graft reconstruction of defects in the glabrous regions of the hand is frequently achieved with skin from nonglabrous donor sites such as the medial forearm. Nonglabrous skin has a poor color and texture match for such applications and is frequently associated with tender and unsightly donor scars. We describe our experiences of harvesting full-thickness grafts from the glabrous skin centered over the proximal flexion crease at the level of the metacarpophalangeal joint of the thumb. We have utilized this site to harvest skin grafts of up to 2 cm in width for the resurfacing of small-sized to medium-sized defects on the palmar surfaces of the hands and fingers in 28 patients under both traumatic and elective circumstances. The skin has an excellent type-match to the defect and is quick and easy to harvest due to its adjacent location to the defect. The donor scar matures quickly, and as it lies along the thumb base crease, it runs along one of the least used contact surfaces, thereby limiting the potential discomfort associated with FTSG harvest sites from other areas. Patient satisfaction with the procedure has been high, and it represents a useful alternative to traditional nonglabrous skin graft donor sites for small-sized to medium-sized defects.

Considerations in Flap Selection for Soft Tissue Defects of the Hand

“…2) and there are several donor sites for glabrous skin to cover palmar defects. 7,8 Regional flaps from the forearm leave conspicuous donor defects and result in significant color mismatch in dark-skinned individuals. These flaps should be reserved for dorsal hand defects because of the good color and texture match.…”

Acute Management of Thermal Hand Burns in Adults

“…However, this may not be necessary for isolated hand burns. Regarding full-thickness grafts, for small glabrous skin defects in the hand, the thenar base donor site has been shown to have minimal donor morbidity 138 …”

Role of microsurgical techniques combined with Ilizarov techniques in limb salvage and functional reconstruction of thermal‑crush injuries of the hand: A case report

“…Soft tissue reconstruction is the major event of limb salvage for thermal-crush injuries of the hand (29). Following the general process of skin defect treatment in hand surgery (30), free skin grafting is often used to repair the wound surface in patients with well-growing granulation and lack of deep tissue exposure. Skin flap transplantation is the only choice for patients with a high demand for wear resistance and weight bearing, and those with a deep tissue exposure.…”