Hand reconstruction following avulsion of all dorsal soft tissues. A cutaneo-tendinous free tissue transfer

Restoration of function following mutilating injuries to the extensor surface of the hand has traditionally involved staged reconstruction with distant pedicle flaps, followed by tendon grafting. Advances in microsurgery now permit the transfer, in one operation, of vascularized composite tissues such as skin and muscle, or skin and bone. For dorsal hand reconstruction a composite flap of skin, tendons and nerves from the dorsum of the foot was transferred in one stage soon after injury, avoiding unnecessary disabling scar formation, prolonged hospitalization and resulting in the rapid restoration of near normal function and appearance of the hand. Donor site morbidity was minimal.