Soft-tissue coverage of the hand

Soft-tissue reconstruction is a fast developing field with a multitude of innovations. This review provides an update on the most recently published reconstructive options for the pulp and the rest of the finger as well as discusses three general trends that can be broadly applied to hand reconstruction: strategies to reduce donor site morbidity with the use of perforator flaps, adipofascial flaps, venous flaps, and dermal substitutes; improving form and function of the reconstructed hand through the use of thin flaps, flap thinning, and combined flaps; ways to increase the reliability of these complex procedures, such as vascular mapping and pedicled flaps. These aims certainly are not new but have taken on a greater importance in recent years. The strategies presented in 2010 and 2011 show a shift towards perforator flaps, mainly pedicled but also free flaps. The basic principles of these flaps can provide a firm base on which further innovation can be built to improve patient outcomes.