Restoration of sensibility in mutilating hand injuries

The restoration of hand sensibility should be a high priority in providing soft tissue coverage for extensive hand injuries. Initial wound management may be effectively provided by conventional techniques, including skin grafts and groin flaps as a first stage. Once the magnitude of the injury is determined and the reconstructive goals are established, many of these procedures can be performed at a second operation. More circumscribed tissue losses, in which restoration of sensibility is the primary reconstructive goal, may be addressed in the acute or semiacute setting with primary sensory flap reconstructions. The advantage of this approach is that dissection of vessels and nerves is generally easier without the problems of scarring and fibrosis, thereby significantly hastening functional recovery.