Reconstruction
Soft-Tissue Reconstruction
The hand has an unusual requirement: its covering has to be both tough enough to grip with and thin and mobile enough to let a fist close. Losing that covering is not a cosmetic problem - it directly limits what the hand can do.
Soft-tissue reconstruction chooses coverage that matches what has been lost and what lies beneath it. The simplest option that meets the requirement is usually the right one.
What the problem looks like
- Skin loss exposing tendon, bone or joint
- Scarring that tethers the skin and restricts movement
- A contracture pulling a finger into a bent position
- Coverage that has healed but is too thin or too tight to work
- Wounds over hardware from previous surgery
Loading anatomy
Principles
How this kind of reconstruction is approached
- 01
Match the covering to the need
Palm skin and the thin skin on the back of the hand do different jobs. Reconstruction aims to restore tissue that suits the site rather than simply closing the hole.
- 02
Grafts need a healthy bed
A skin graft has no blood supply of its own and takes one from the tissue beneath. Over exposed bone or tendon there is nothing to take from, so a graft will not survive.
- 03
Flaps bring their own supply
A flap moves tissue with its blood supply intact. That is what allows it to cover bone, tendon and hardware, and to provide a surface tendons can glide beneath.
- 04
Release, then resurface
A contracture is released first; only then is the true size of the defect visible. Reconstruction follows the release rather than preceding it.
- 05
Plan for movement
Coverage that heals but tethers has traded one problem for another. Thickness, glide and scar direction are all part of the plan.
Clinical detail
Options include split- and full-thickness grafting, local flaps, homodigital and heterodigital island flaps, regional pedicled flaps from the forearm, and free tissue transfer.
Selection accounts for the exposed structures, the requirement for a gliding surface, durability at the contact area, donor-site morbidity and the need for secondary procedures.
Scar contracture release uses established techniques of local tissue rearrangement where the surrounding tissue is adequate, and resurfacing where it is not.
Related conditions
Complex Wounds
Wounds of the hand or upper limb that will not heal on their own, or that expose bone, tendon, joint or hardware and need durable coverage.
Complex Hand Trauma
Severe injuries that damage more than one tissue system at once - bone, tendon, nerve, blood vessel and skin together.
All reconstruction categories · Revision & secondary surgery
Discuss soft-tissue reconstruction
Consultations begin with understanding your symptoms, what you can no longer do comfortably, and what has already been tried.