Use of the free innervated dorsalis pedis tendocutaneous flap in composite hand reconstruction

We used the free dorsalis pedis flap including the extensor digitorum longus or the extensor hallucis brevis, and/or the superficial peroneal nerve to reconstruct composite loss of skin and tendons on the dorsum of the hand. Between February 1992 and February 1996 we treated 7 patients with composite tissue loss on the dorsal hand caused by trauma or burn. Six men and 1 woman had an average age of 26 years (range, 19-42 years). Flap size ranged from 3 x 4 cm to 9.5 x 9 cm. The follow-up period ranged from 10 to 44 months. At 1 week postoperatively, active flexion and passive extension commenced, and progressive resistance exercises were performed for an additional 5 weeks. Two-point discrimination of the transferred flaps averaged 25 mm. Recovery rates for range of motion of the metacarpophalangeal joints in the operated fingers ranged from 83% to 99% (average, 91.4%). All transferred flaps showed similar color match and skin texture compared with the normal skin of the hand. The advantages of this procedure are mass action reconstruction with multiple tendons, provision of similar skin texture, sensory reinnervation, one-stage operation, faster healing with less adhesion formation, and early mobilization. The disadvantages are donor site scarring and weak extension of the toe.