Flap Selection for Hand Reconstruction: A Review of Indications, Local and Regional Techniques, and Outcomes

Traumatic hand injuries often require flap-based reconstruction to restore durable coverage, preserve motion, and support functional recovery. This review outlines a practical, anatomy-driven approach to flap selection, emphasizing the principles of the reconstructive ladder while integrating region-specific considerations.

Each flap type was examined with attention to surgical technique, anatomical design, indications, and outcomes. Flaps discussed include local advancement, rotation, and transposition flaps, as well as regional options such as cross-finger, thenar, forearm artery-based, and posterior interosseous artery flaps.

Local flaps offer reliable solutions for small, well-vascularized defects with minimal donor site morbidity. Regional flaps provide broader coverage without the need for microsurgical anastomosis and preserve major arterial supply. Flap selection depends on the patient-specific factors, location and complexity of the defect, availability of donor tissue, and functional requirements of the reconstructed region.

Optimal hand reconstruction requires aligning flap characteristics with wound demands and patient-specific goals while balancing durability, function, sensation, and cosmesis. Mastery of anatomy and operative versatility allows surgeons to optimize coverage, function, and long-term outcomes across a wide range of upper extremity injuries.