Neurosensory free flaps to the hand. Indications and donor selection

When used in properly selected cases, a neurosensory free flap provides sensibility, vascularity, and soft-tissue coverage to an injured hand. Appropriate selection of donor flaps based on the need for fine discriminatory or protective sensation is important for optimal results. Because of its thin, glabrous skin and a constant vascular and neural anatomy, the first web-space flap of the foot or its variants provide the best reconstructive choice for restoration of critical sensibility to digital tips or anesthetic amputation stumps. Protective sensibility can be restored with other neurosensory free flaps, but more clinical experience is needed to fully evaluate the reconstructive potential of many described flaps. A distinction must be made between the anatomic description of a free flap with neurosensory potential and the report of long-term sensory ability after clinical transfer.