Reconstruction of the loss of substance of the dorsum of the hand: from the conventional techniques to regenerative surgery procedures

Abstract

AIM: Our aim is focused on the advantages of new technologies compared with those of traditional methods in the reconstruction of the loss of substance of the dorsum of the hand.

MATERIAL OF STUDY: We observed 37 patients from 2007 to 2010 with loss of substance of the dorsum of the hand, also associated with significant comorbidities. In 27 patients we chose surgical reconstruction, in 10 patients we opted for conservative reconstruction with the use of new technologies.

RESULTS: After a median follow-up from one to three years, in all cases the skin coverage was reinstated and mobility was restored, thereby adhering to the principles of both morphological and functional reconstruction.

DISCUSSION: Concerning reconstruction by means of flaps, the main principles dictate is the new coverage must appear as much as possible, similar to the original tissue. The reconstruction must be in a single surgical time. On the other hand, the advent of advanced dressings and bioengineering has optimized conservative skin repair.

CONCLUSIONS: We have seen a considerable broadening of the indications for conservative reconstruction. This method is suitable for reconstruction of the dorsum of the hand with good effectiveness, it makes it possible to obtain a tissue of good quality, which is flexible and smooth on the tendons and is not excessively thick. These methods are achieved with relative ease even in patients with poor general health. Although costly, this procedure will ultimately save the patient from further surgeries and hospitalization expenses, making it advantageous when considering the benefit-cost ratio