Tendinous cutaneous dorsal hand injuries. One-stage reconstruction

The reconstruction of complex cutaneous tendinous dorsal hand injuries represents a problem that is not easy to solve. The transferral in a single surgical stage, with a single flap, of skin, tendons, and nerves, all completely vascularized, is probably the ideal solution. Between 1988 and 1999 the one-stage reconstruction method was used in 13 patients. A cutaneous tendinous dorsalis pedis free flap was used in 7 cases, and a cutaneous tendinous radial forearm island flap with an inverted flow was used in 6. The dorsalis pedis flap allows for the inclusion of 4 tendons that are completely vascularized (extensor digitorum communis), while the radial flap allows us to completely insert a single tendon (palmaris brevis) and two vascularized tendinous strips taken from the flexor carpi radialis and from the brachioradialis. All of the flaps transferred survived perfectly with good functional recovery. One-stage reconstruction that is "completely vascularized" allows us to reduce the amount of time spent in hospital, the number of operations, and above all it provides cosmetic and functional results that are close to normal. The dorsalis pedis flap is indicated in cases of cutaneous tendinous dorsal hand injuries that require the simultaneous reconstruction of three or four extensor tendons. On the other hand, the radial flap may be used in situations where it is necessary to reconstruct only 1 or 2 tendons.