I LEMBI AD ISOLA REVERSE DI AVAMBRACCIO NELLA RICOSTRUZIONE DEL DORSO DELLA MANO

The reverse island forearm flaps for the dorsal hand reconstruction SUMMARY Purpose: Injuries of the dorsum of the hand, characterized by wide loss of soft tissue, are caused by many mechanisms, with prevalence of mechanical traumas and particularly crushing injuries. The authors present their experience with these injuries, underlining the indications on how to choose the most ideal flap to reconstruct the dorsum of the hand. Methods: Nine patients which sustained severe injuries to the back of the hand were recruited and treated with rota- tion-of-island reverse flaps from the forearm, including fascia or fascio-cutaneous layers, for the treatment of isolated soft tissue lesions or more complex injuries. Functional evaluation was performed in all patients with a long follow-up pe- riod of 2 years, using the Strickland method. Results: The gold standard for the treatment of injuries on the dorsum of the hand is through the use of the distally based Radial Artery Flap which is reliable, easy to dissect and capable of cove- ring large exposed areas. The alternative choices are the other reverse island flaps of the forearm, like the Posterior Inte- rosseous and the Ulnar Artery flaps, while the reconstructive option through the use of free flaps is considered as a last re- sort. Conclusions: The use of the radial forearm fascia flap is usually preferred to the fascio-cutaneous one, because the former leaves a smaller scar at the donor site and because it offers greater pliability, thinness and versatility, which makes it ideal for reconstructing the soft-tissues on the dorsum of the hand. On the other hand, the radial fascio-cuta- neous flap is indicated when the loss of soft tissue on the dorsum of the hand is associated with exposed, comminuted and contaminated fractures that require a more extensive coverage of the osteosynthesis. Riv Chir Mano 2005; 2: 77-87