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Refining Outcomes in Dorsal Hand Coverage: Consideration of Aesthetics and Donor-Site Morbidity

Parrett, Brian M. M.D.; Bou-Merhi, Joseph S. M.D.; Buntic, Rudolf F. M.D.; Safa, Bauback M.D.; Buncke, Gregory M. M.D.; Brooks, Darrell M.D.

Plastic & Reconstructive Surgery: November 2010 - Volume 126 - Issue 5 - pp 1630-1638
doi: 10.1097/PRS.0b013e3181ef8ea3
Hand/Peripheral Nerve: Original Articles
Discussion

Background: With high success rates, flap survival should no longer be the sole criterion in judging success in dorsal hand and wrist reconstruction. The authors sought to determine the best flap for dorsal hand coverage in terms of aesthetic appearance, donor-site morbidity, and minimization of revision surgery.

Methods: A retrospective review of all free flaps for dorsal hand and wrist coverage from 2002 to 2008 was performed. Flaps were divided into four groups: muscle, fasciocutaneous, fascial, and venous flaps. Outcomes assessed included need for debulking, blinded grading of aesthetic outcomes, and flap and donor-site complications.

Results: A total of 125 flaps were performed with no flap losses. There was no difference in partial loss or infection among the different flap groups. There was a significant range in the need for future debulking procedures, with debulking required in 67 percent of fasciocutaneous, 32 percent of muscle, 5.8 percent of fascial, and 0 percent of venous flaps. There was a significant difference in aesthetic outcomes: venous flaps had the best overall aesthetic outcomes; fascia and muscle flaps scored equally in terms of overall aesthetics, color, and contour match; and fasciocutaneous flaps had significantly worse aesthetic, contour, and color match results compared with all other flap types. Fasciocutaneous flaps had greater donor-site morbidity in terms of need for skin grafting and wound breakdown.

Conclusion: The aesthetic outcome of dorsal hand reconstruction is dependent on flap choice, with statistically significant differences in revision surgeries and aesthetics among flap types.

San Francisco, Calif.

From the Buncke Clinic, California Pacific Medical Center.

Received for publication February 22, 2010; accepted May 3, 2010.

Presented at the American Society for Reconstructive Microsurgery 2010 Annual Meeting, in Boca Raton, Florida, January 6 to 11, 2010.

Disclosure: The authors have no financial disclosures, commercial associations, or conflicts of interest to report.

Darrell Brooks, M.D., The Buncke Clinic, CPMC, 45 Castro Street, Suite 121, San Francisco, Calif. 94114, darrellbrooks@usa.net

©2010American Society of Plastic Surgeons