Management of composite hand defects using free rectus abdominis muscle flap

Abstract

Background: Hand injuries are the main cause of work-related disability in young adults. Wound coverage after a complete degloving injury of the hand and fingers is of the most difficult problems in hand surgery. The goal of treatment is to cover the hand defects with pliable, sensitive, and cosmetically similar tissues that will allow early rehabilitation and protect the underlying structures. The covering flap was chosen according to the functional and aesthetic needs with less donor site morbidity. Combined defects can be reconstructed with composite tissue flaps. So the aim of this study is to use the rectus abdominis muscle free flap for reconstructing the hand defects to improve the functional hand disability, with better cosmetic shape and less donor site morbidity. Patients and methods: 18 patients with acute traumatic hand defects were enrolled in this study. The follow up time ranged from 6-9 months postoperatively and were reconstructed by free rectus abdominis muscle flap and converge of the muscles by STSG Results: No flap loss occurred in this study. The scars healed well, and the patient was fully ambulant. Complication included; hematoma, ischemia, infection and disruption. The STSG showed 10% loss in one case and 30% loss in another case. As for the donor site, early complication showed seroma in 2 cases and wound disruption in one case which was left to heal conservatively. Conclusion: Adequate coverage of soft tissue associated with major hand injuries ensures primary healing, protects the reconstruction of the underlying structures and facilitates early rehabilitation