Versatility of the Reverse Dorsoulnar Fasciocutaneous Flap in Coverage of Hand Defects: Clinical Experience With 36 Cases

Purpose Local flap reconstruction is often required for soft tissue defects of the hand. The optimal reconstruction method should provide thin, supple, well-vascularized tissue with minimal donor-site morbidity. Short operating time and a sizable pedicle for microsurgical anastomosis are helpful. In this study, outcomes of hand defects after reconstruction with a reverse dorsoulnar flap were retrospectively analyzed. Methods Between 2001 and 2008, 36 patients were evaluated (28 men, 8 women). Twenty-seven pedicle flaps and 9 free flaps were used. Nineteen patients had flexion contractures in their palms and fingers after burn injuries, 14 patients had traumatic soft tissue loss, and 3 patients had defects after tumor exicision. In 26 cases the defects were on the palm site, and in 10 cases the defects were on the dorsum of the hand. Mean follow-up was 12 months. Results The success rate was 100%, with satisfactory cosmetic results. Functional recovery of the hands showed good results as well as acceptable donor healing without complication. Conclusions The dorsoulnar flap as either pedicle or free flap provides good and reliable skin cover for substantial soft tissue defects on the palm, dorsum of the hand, and the fingers. (J Hand Surg 2009;34A:1327-1333. (C) 2009 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)