Neurovascular flaps to the hand

The surgical return of sensibility in the injured upper extremity remains a major goal for the reconstructive surgeon. Free flaps have created the opportunity for successful reconstruction in those patients in whom irreplaceable sensory end organs have been destroyed. In addition, well-vascularized composite tissues may be transferred in continuity with the dorsalis pedis and forearm flaps, allowing for one-stage reconstructions. Extra blood supply is brought to a scarred area in a single step, unlike the multi-stage transfer of distant parasitic tissue. Donor site morbidity remains a problem with many of these flaps, and skin grafts are often required. Many of the larger flaps do not have a close skin match to the skin of the volar hand. There are reports of achievement of protective sensibility with use of all of these flaps. However, experience with fine two-point discrimination has been limited to only the first web space flap. This return to near normal sensibility in the hand remains a standard by which all these flaps must be judged.