Fascial flap reconstruction of the hand: a single surgeon's 30-year experience.
BACKGROUND
The reconstruction of complex hand wounds is challenging due to the requirements for thin and pliable coverage with a reliable vascular supply, potential for sensibility, and provision of a gliding surface. Fascial flaps represent an excellent option for the reconstruction of these complicated defects.


METHODS
A retrospective review of fascial flap reconstructive procedures to the hand undertaken by a single microsurgeon was performed for operations occurring between 1979 and 2009. Both pedicled and free tissue transfer procedures were included in both pediatric and adult patients. Data were culled from a combination of patient charts, hospital records, radiographic studies, and clinical photographs.


RESULTS
Sixty fascial flap reconstructive procedures to the hand were analyzed in 60 patients from the defined 30-year period. The most common pathological process necessitating reconstruction was acute trauma (n = 32, 53 percent). Most of the soft-tissue injuries included in the study sample were located on the dorsal hand and wrist (n = 27, 45 percent). The most commonly utilized reconstructive modality was the temporoparietal fascial flap (n = 35, 58 percent). Most reconstructions were completed as free tissue transfers (n = 46, 77 percent). Perioperative complications were relatively minor; no flap losses were recorded. All cases studied demonstrated excellent long-term coverage with no evidence of underlying tendon adhesion or contracture.


CONCLUSIONS
Fascial flaps represent an excellent option for coverage of soft-tissue defects of the hand that are not amenable to reconstruction with skin grafting alone, particularly for localized defects with denuded tendons or exposed joints.
Carty
Matthew J
MJ
Department of Surgery, Brigham and Women's/Faulkner Hospital, 1153 Centre Street, Jamaica Plain, MA 02130, USA. mcarty@partners.org
Taghinia
Amir
A
Upton
Joseph
J
D000062:Accidents, Occupational; D000328:Adult; D005260:Female; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D013933:Thumb / Q000293:injuries