Free Flap Reconstruction for Severe Hand Injuries Involving Palmar Soft Tissue Defects: a Case Series

Abstract

　This study retrospectively examined 13 hands of 13 patients with severe hand injuries involving palmar defects who underwent free flap reconstruction during the acute phase. Concomitant injuries of the dorsal hand and fingers were common. The medial plantar artery (MPA) flap, the first-choice method for palmar reconstruction, was used in five cases; however, in many patients, it could not be applied because of extensive injury or complex flap design. In such cases, a superficial circumflex iliac artery perforator (SCIP) flap was actively used as a second-line option. Arterial anastomosis was performed within the palm in approximately half of the patients, whereas venous anastomosis was often performed outside the palm. Sensory nerve coaptation was performed in only two cases. These findings highlight that careful flap selection and planning of recipient vessels, considering the extent of the defect and flap design, are critical for successful free flap reconstruction in acute severe palmar injuries.