[Hand surgery. Soft tissue defects]

The presence of soft tissue defects in the hand indicates serious traumatic damage that may compromise the systems involved in movement, circulation or touch and therefore jeopardize functional rehabilitation. This overview highlights the significance and the various causes of soft tissue defects. Several types are distinguished. Selection criteria for various flap procedures are outlined with reference to the need for elevation of the hand, the necessity for early movement, adequate wound drainage, and range of motion therapy. The characteristics required of flap tissue are described, such as surface characteristics, ability to restore sense of touch, cosmetic appearance, ability to close deep volume defects, and potential for revascularization of adjacent tissue. Finally, commonly used, selected flaps are presented with notes on their advantages, disadvantages, and modifications, the techniques required and the indications for each.