Neurosensory free flaps. Digits and hand

Area of Science:

• Reconstructive surgery
• Hand surgery
• Microsurgery

Background:

• Complex soft-tissue defects of the hand and fingers present significant reconstructive challenges.
• Restoration of functional mobility and sensation is crucial for optimal outcomes.
• Donor site selection is critical for successful soft-tissue reconstruction.

Purpose of the Study:

• To review strategies for reconstructing complex soft-tissue defects of the hand and fingers.
• To evaluate donor tissue options for restoring sensibility and function.
• To highlight the importance of surgeon expertise in managing these challenging cases.

Main Methods:

• Review of current literature and surgical techniques for soft-tissue reconstruction of the hand.
• Analysis of donor tissue characteristics, focusing on sensibility and functional restoration.
• Discussion of flap options, including free-tissue transfer from the toes.

Main Results:

• Glabrous skin and pulp from the great toe provide the highest level of critical sensibility for finger defects.
• Tissue from the second toe offers a secondary option for sensibility restoration.
• Flaps like the lateral arm or radial forearm can effectively reconstruct defects in the palm, dorsum, or first web space, providing protective sensibility.

Conclusions:

• Free-tissue transfer from the great toe is the preferred method for restoring critical sensibility in finger defects.
• Various flaps can be utilized for hand reconstruction, with the choice depending on defect location and sensibility requirements.
• Successful management of complex hand soft-tissue defects relies heavily on the surgeon's judgment and technical skill.