title: Local fasciocutaneous sliding flaps for soft-tissue defects of the dorsum of the hand.
abstract: OBJECTIVE
  Appropriate coverage of defects that expose tendon, joints, and/or neurovascular structures is necessary to preserve optimal hand function. Local, random-pattern flaps and skin grafts may be inadequate because of the hand's finite skin reservoir or the presence of a poorly vascularized and mobile wound bed. Described herein is a novel method of dorsal hand reconstruction.
  
  
  METHODS
  A fasciocutaneous sliding flap and the underlying vascular anatomy of the dorsal hand are described. The flap takes advantage of the distinct fascial layers of the hand by raising the skin and fascia with bilevel undermining.
  
  
  CONCLUSIONS
  The proposed single-stage, bilevel undermined fasciocutaneous sliding flap based on the perforating vessels running through fascial septae recruits pliable, easily mobilized skin, preserves neurosensory innervation, and facilitates early hand mobilization with reduced postoperative care. This flap, and its proposed variations, are ideal for use when paratenon is exposed and immobilizing the hand would be necessary for graft survival or when tension at the wound precludes reconstruction with primary closure or a traditional flap.
authors: Division of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia.
authors: Joseph F
authors: JF
authors: Sobanko
authors: Division of Plastic Surgery, Department of Surgery, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia.
authors: John
authors: J
authors: Fischer
authors: Division of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia.
authors: Jeremy R
authors: JR
authors: Etzkorn
authors: Division of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia.
authors: Christopher J
authors: CJ
authors: Miller
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006085:Graft Survival; D006225:Hand; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps