Reconstruction of severe soft tissue defects of the hand

Background. Severe soft tissue defects of the hand are often caused by occupational trauma and frequently lead to considerable functional impairment. Objective. Which reconstructive options and what supportive treatment measures are available for severe soft tissue defects of the hand? Material and methods. A representative summary of treatment measures concerning primary care and further covering of defects as exemplified by selected cases from our own patients and additional recommendations for treatment are presented. Results. The reconstruction of severe soft tissue defects of the hand usually consists of several steps and is performed according to individual patient needs. For this purpose, different types of local, pedicled and free flaps are available. Conclusion. Hand surgery provides a wide range of options for the reconstruction of tissue defects of different etiologies. The spectrum of operative procedures encompasses both local and pedicled flaps as well as free flaps taken from other regions of the body with microvascular connection to the recipient region. Free flaps are an essential pillar in the reconstructive treatment and due to the safety in the execution, the application of free flaps should not only be seen as a last resort. Many kinds of free flaps can be harvested with parts from different tissue types or as a combination of several free flaps. As a result individual solutions can be provided depending on patient needs. Supportive measures following free flap surgery can help to improve the postoperative result with respect to blood supply, complaints and function.