Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Dorsal Hand Reconstruction
Clinical Presentation
A 41-year-old White male had a degloving injury of his right hand as a result of a motor vehicle accident. He sustained a large soft tissue open wound, measuring 9 × 8 cm, over his dorsal hand with the underlying bones and extensor tendons exposed. He was managed initially by the trauma service and the plastic surgery service was consulted for soft tissue reconstruction of the dorsal hand wound ( Fig. 19.1 ). Preoperative evaluation using the Allen test confirmed an adequate blood supply to the right hand.
Operative Plan and Special Considerations
Based on the size and location of the soft tissue defect over the dorsal hand, a reversed radial forearm fasciocutaneous flap can be a good option. The flap is reliable and has a long pedicle for easy flap inset. It can provide durable soft tissue coverage to a dorsal hand wound. The Allen test should be performed preoperatively to evaluate the ulnar artery system to ensure there is an adequate blood supply to the hand when the radial artery is sacrificed after the flap elevation. A suprafascial flap dissection can be performed to improve donor site cosmesis after a skin graft procedure for the donor site closure.
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