Assessment of the Gliding of Extensor Tendons in Post-Traumatic Hand Defects Reconstructed Using Muscle Flaps Versus Fascio-Cutaneous Flaps

Abstract

Background: Use of fascio-cutaneous or fascial flaps are well known methods of reconstruction of dorsal hand defects to preserve the gliding movement of the extensor tendons. Whilst reconstruction of large hand defects extending to the wrist or the distal forearm entails use of larger flaps with large donor sites, so muscle flaps may have an advantage over the fascial or fascio-cutaneous flaps in coverage of these large defects. The aim of this study is to compare the gliding of the extensor tendons underneath fascio-cutaneous and muscle flaps on the dorsum of the hand. Patients and Methods: The study included 20 patients with dorsal hand trauma with exposed extensor tendons, ten defects were reconstructed by free muscles flap and split thickness skin graft and the other ten were reconstructed with fascio-cutaneous flaps. Early rehabilitation in all cases was done by a single dedicated physiotherapist. Tendon gliding was assessed by measurement of active flexion and extension at the metacarpo-phalangeal joint using goniometer after complete flap healing four months following flap inset. Results: There was no statistically significant difference in gliding for extensor tendons in patients with hand defects reconstructed by free muscle flaps and skin graft versus fasciocutaneous flaps. Conclusion: Both fascio-cutaneous and free muscle flaps had comparable results concerning the extensor ttendons gliding underneath. Key Words: Hand trauma – Fasciocutaneous flaps – Muscle