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Page 8 of 11 Yamakawa et al. Plast Aesthet Res 2020;7:24 I http://dx.doi.org/10.20517/2347-9264.2020.20

A B

C

Figure 8. A 62-year-old man 10 months after reconstructive surgery for dorsal hand skin and extensor tendon defects. A: the color
matching was good; B: extension of the index finger was close to full; C: all index finger joints have slightly limited flexion

Currently, distant, free, or local flaps are generally used to cover dorsal hand defects [Table 1]. Distant
flaps, including abdominal, groin, and intercostalis flaps, are simple and good options for large defects [12-14] .
However, they require at least two surgeries and prolonged recovery periods. Although blood supply of
these flaps is reliable, the risks of elbow or shoulder contracture are higher than other options due to the
prolonged recovery period. In addition, it is difficult to reconstruct thin and pliable skin.

Free flaps, including anterolateral thigh flaps, lateral arm flaps, and scapular flaps, enable one-step
[15]
reconstruction . Moreover, donor site morbidity can be minimized, and the extensor digitorum tendon
[16]
and its gliding surface can be reconstructed as required. Muneuchi et al. reported that a free anterolateral
thigh fasciocutaneous flap was useful to fill the dead space of a dorsal hand defect after resection of
the bursa, and the flap also aided in reconstructing a two-layer gliding surface of the extensor tendons.
However, as the arteries and veins are usually damaged, anastomosis of vessels is problematic.

Local flaps, including the retrograde posterior interosseous flaps and retrograde forearm flaps, have good
color and texture matching for dorsal hand reconstruction . However, retrograde posterior interosseous
[17]
flaps require meticulous dissection and the posterior interosseous artery in the middle of the forearm
varies. Furthermore, the presence of distal communication between the posterior interosseous artery
[17]
and the anterior interosseous artery must be confirmed . If communication between the two vessels is
unsatisfactory, this flap cannot be used for reconstruction. Moreover, retrograde posterior interosseous
flaps have been reported to have relatively high complication rates such as flap necrosis [18-20] .