Considerations in Flap Selection for Soft Tissue Coverage of the Hand and Digits

Area of Science:

• Reconstructive surgery
• Hand surgery
• Microsurgery

Background:

• Reconstructive hand surgery aims for functional and aesthetic restoration.
• Soft-tissue defects in the hand and digits present complex challenges.
• Perforator and local flaps are crucial reconstructive options.

Purpose of the Study:

• To evaluate perforator-based and local flaps for hand and digit soft-tissue reconstruction.
• To assess functional reliability, anatomical consistency, complication profile, and aesthetic integration.
• To analyze outcomes in a high-complexity referral population.

Main Methods:

• Retrospective single-center study of 37 patients (Sept 2021 - Sept 2024).
• Analysis of defect characteristics, flap selection, and surgical techniques.
• Inclusion of various perforator flaps: dorsal metacarpal artery, reverse radial forearm, reverse posterior interosseous, island flaps, and thenar flap.

Main Results:

• Satisfactory soft tissue coverage achieved in 35/37 patients.
• High success rate with stable integration and durable coverage.
• Favorable functional outcomes with restored joint mobility and no secondary deformities.

Conclusions:

• Perforator and local flaps are effective for upper extremity reconstruction.
• Individualized surgical planning is essential for optimizing outcomes.
• These flaps offer reliable solutions for complex soft-tissue defects.