Neurosensory free flaps. Digits and hand

Repairing complex soft-tissue defects of the hand and fingers remains a daunting task. Maintenance of functional mobility and sensibility are paramount in determining donor-site tissue. Critical sensibility is important for defects of the fingers and can be replaced only with tissue from the palmar surface of the hand itself or by free-tissue transfer from the toes. In this regard, glabrous skin and pulp from the great toe demonstrates the most critical level of sensibility, followed by tissue from the second toe. Complex soft-tissue defects of the palm, dorsum of the hand, or first web space can be replaced effectively by flaps that provide protective sensibility. The standard flaps employed are the lateral arm or radial forearm. The ultimate consideration in dealing with these difficult problems must be determined by the judgment and technical sophistication of the surgeon.