Due to these disadvantages, fasciocutaneous flaps have become our secondary choice for dorsal hand reconstruction.There are two advantages of fasciocutaneous flaps. First, flap re-elevation is easier than with muscle flaps.Second, flap tissue can be rearranged and divided with less concern for blood supply as would be needed in a muscle flap; a few months after flap transfer, fasciocutaneous flaps appear to be less reliant on the primary pedicle. In addition, if patients will require secondary reconstructions, then debulking can be done at this time.
Fascial flaps with split-thickness skin graft are thin and pliable. These scored high in all aesthetic categories and rarely needed debulking. Donor-site morbidity is minimal, as no muscle is harvested and the donor site is closed primarily without need for grafting.We have been increasingly using partial muscle flaps for dorsal hand and wrist coverage in which the flap size harvested is tailored to the defect size. These are harvested as a partial superior latissimus muscle or as a partial medial rectus muscle flap, leaving the majority of the donor muscle and its motor nerve intact. These are small, custom-designed flaps.………Despite the teaching that fascia is needed for tendon glide, we have noted no difference in tendon functional results when covered with muscle versus fascia. This conceptually makes sense, as normally tendons and muscle bellies constantly glide past each other in the forearm.
For these reasons, fascial flaps are a first-line treatment for moderate-sized to large dorsal hand wounds, allowing a single-staged procedure with minimal need for revision surgery. Their aesthetic appearance is better than that of fasciocutaneous flaps, and they require less debulking than muscle flaps.