Distal-based flaps for reconstruction of hand burns

Any burn injury, even if considered minimal in extent, can still be catastrophic, if hand burns are severe enough to result in deformities that render the individual unable to perform his own personal daily functions. Usually any necessary skin coverage of the hand can be achieved with skin grafts alone; but occasionally, seemingly heroic measures requiring vascularized flaps will be justified to ensure maximum rehabilitation. Previously, available options included proximal-based local flaps, or distant flaps either pedicled while remaining attached to another body region, or transferred immediately by use of microsurgical techniques. Another new concept that may still be somewhat in the investigational stage for burns is the distal-based local flap. These use more traditional proximal skin territories, but with a distal vascular pedicle that can allow such flaps to reach even the fingertips. More expeditious and technically simpler than the transfer of distant flaps, this alternative deserves further consideration in the appropriate circumstances.