title: [Functional and aesthetic refinements of free flap coverage at the dorsum of the hand and distal forearm].
abstract: BACKGROUND
  Free coverage of exposed functional structures of the hand and distal forearm can be achieved using a variety of free flaps. However, there is a lack of data in the literature which tissue components are best used for defect coverage of this specific area regarding aspects such as tendon gliding and tissue elasticity. The purpose of this retrospective study was to compare and to evaluate the functional and aesthetical results using free cutaneous, fascial and muscle flaps.
  
  
  METHODS
  Between 1994 and 2002, a total of 56 patients underwent free flap coverage at the dorsal side of the hand and forearm at our institution. Of these patients, 20 with 21 free flaps met the study criteria and were available for follow-up examination. Depending on the tissue component used patients were allocated into three different groups. In group 1 eight patients received a fascial flap, in group 2 eight a cutaneous flap and in group 3 five a muscle flap. The mean follow-up was 50 months (range: 4-103 months). At follow-up examination the patients answered the Client Satisfaction Questionnaire (CSQ 8) and the DASH questionnaire.
  
  
  RESULTS
  Regarding range of motion of the wrist and fingers, fascial flaps clearly showed the best results. Concerning grip strength and pinch grip, fascial and cutaneous flaps demonstrated the same results. Patients with cutaneous flaps showed the best DASH score. Regarding the overall aesthetical outcome, fascial and cutaneous flaps were far better than muscle flaps. Donor site morbidity was lowest for fascial flaps followed by muscle flaps and was highest for cutaneous flaps.
  
  
  CONCLUSIONS
  Cutaneous and fascial flaps had the best functional and aesthetical results. Fascial flaps achieved the best aesthetical outcome of the donor site. We recommend free fascial flaps and cutaneous flaps as the first choice due to their advantages in the specific area of the dorsal site of the hand and distal forearm which requires pliable and thin tissue coverage.
authors.affiliation: Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Plastische und Handchirurgie der Universität Heidelberg, 67071 Ludwigshafen. t.gohla@t-online.de
authors.forename: T
authors.initials: T
authors.lastname: Gohla
authors.forename: A
authors.initials: A
authors.lastname: Kehrer
authors.forename: G
authors.initials: G
authors.lastname: Holle
authors.forename: K
authors.initials: K
authors.lastname: Megerle
authors.forename: G
authors.initials: G
authors.lastname: Germann
authors.forename: M
authors.initials: M
authors.lastname: Sauerbier
mesh_terms: D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D005260:Female; D005542:Forearm / Q000601:surgery*; D006225:Hand / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D020127:Recovery of Function; D012867:Skin / Q000293:injuries*; D013524:Surgical Flaps; D016896:Treatment Outcome