Moderate to large dorsal hand defects pose reconstructive challenges owing to the small surface area, immobile adjacent finger tissue, and thin, fragile skin.To present reconstructive options for moderate to large dorsal hand defects.First, a brief review of dorsal hand reconstructive options is discussed. Then, three approaches to reconstructing dorsal hand defects are presented based on the amount of available underlying tissue and location of the defect on the hand.In the authors' opinion, for larger defects on the mid-distal 1st-3rd metacarpals, the single arm rotation flap is preferable. For medium-sized defects with underlying soft tissue, a Burow's graft is appropriate. The O-Z flap is best for medium- to large-sized defects on the proximal half of the metacarpals. Defects of the digits are excluded.The O-Z rotation flap, single arm rotation flap, or Burow's graft can be used to reconstruct the majority of moderate to large dorsal hand defects.
Brett C Neill, Erin Roberts, Stanislav N Tolkachjov