Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Palmar Hand Reconstruction
Clinical Presentation
A 29-year-old White female had a thermal burn injury to her right hand. She sustained a large soft tissue open wound, measuring 9 × 6 cm, over her palmar hand with the underlying bones and flexor tendons exposed. The palmar wound also extended to the volar thumb. She was managed initially by the burn service and the plastic surgery service was consulted for soft tissue reconstruction ( Fig. 20.1 ). A preoperative Allen test confirmed an adequate blood supply to the right hand via the ulnar artery system.
Operative Plan and Special Considerations
Based on the location and size of the soft tissue defect over the palmar hand, a reverse radial forearm fasciocutaneous flap could also be a good option. The flap is reliable and has a long pedicle for an easy flap inset. It can provide durable soft tissue coverage to a palmar 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 rather than subfascial flap dissection can be performed to improve donor site cosmesis after a skin graft procedure for the donor site closure.
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