Traumatic hand reconstruction: modern surgical approaches and decision-making
DOI:
https://doi.org/10.18203/2349-2902.isj20260358Keywords:
Traumatic hand injuries, Hand reconstruction, MicrosurgeryAbstract
Traumatic hand injuries represent a complex reconstructive challenge due to the need to restore function, sensibility, and aesthetic appearance simultaneously. Injury patterns range from isolated fingertip loss to severe crush, avulsion, and blast trauma, requiring individualized and often staged surgical strategies. Contemporary traumatic hand reconstruction emphasizes algorithmic decision-making based on defect location, size, and exposed structures, guiding the selection from skin grafts and local flaps to regional and free tissue transfer. Core surgical principles include meticulous debridement, skeletal stabilization, vascular repair when indicated, and early provision of stable soft-tissue coverage, followed by secondary reconstruction of tendons, nerves, and bone as needed. Microsurgical techniques, including thin free flaps and toe-to-hand transfers, have become central in the management of complex defects, demonstrating high survival rates and meaningful functional recovery in both adult and pediatric populations. Increasing attention to aesthetic–functional balance, donor-site morbidity, and structured rehabilitation has further improved long-term outcomes. This state-of-the-art review summarizes current principles, algorithms, and evolving surgical approaches in traumatic hand reconstruction.
Metrics
References
Jung S, Lee S, Eun S. Free Flap Reconstruction of Traumatic Skin Defects of the Entire Hand Dorsum. J Clin Med. 2025;14(4):1308. DOI: https://doi.org/10.3390/jcm14041308
Roh S, Lee JH, Koh SH, Kim JS, LEE DC, Lee KJ. Microsurgical reconstruction for traumatic hand defects in pediatric patients. Arch Hand Microsurg. 2022;27(4):320-8. DOI: https://doi.org/10.12790/ahm.22.0021
Zamora JCC, Guerrero CEL. “Hand Reconstructive Surgery Current Indications”. Int J Med Sci Clin Res Stud. 2025;5(10):1771-3.
Gómez SG, Resendiz EAS, Contreras RC, Arteaga MFP. “Heterotopic Hand Reconstruction for Catastrophic Hand”. Int J Med Sci Clin Res Stud. 2025;5(6):897-900. DOI: https://doi.org/10.47191/ijmscrs/v5-i06-12
Woznica V, Billich R, Třešková I. Loss injuries of the hand. Rozhl Chir. 2024;103(10):387-99. DOI: https://doi.org/10.48095/ccrvch2024387
Tiengo C, Bassetto F, Vindigni V. First web space reconstruction in acquired defects: a literature-based review and surgical experience. J Clin Med. 2025;14(5):3428. DOI: https://doi.org/10.3390/jcm14103428
Vizcay M, Pérez Cano R, Saavedra M. Tailored skin flaps for hand reconstruction. Plast Reconstr Surg. 2022;150(4):e4538. DOI: https://doi.org/10.1097/GOX.0000000000004538
Gad GS, Saied S, Mohamed MA, Hifny MA. Flap Selection Approach for Hand Soft Tissue Defects Reconstruction: Surgical Techniques and Outcome Evaluation. SVU-Int J Med Sci. 2021;2:3. DOI: https://doi.org/10.21608/svuijm.2021.49987.1045
Hu W, Kerfant N, Henry AS, Trimaille A, Monnerie C, Artz M, et al. Aesthetic functional reconstruction of the mutilated hand: Indications and selection of reconstructive techniques. Ann Chir Plast Esthet. 2020;65(5-6):635-54. DOI: https://doi.org/10.1016/j.anplas.2020.07.011
Khurshid J, Baba UF, Zargar HR, Bhat BA. Hand injuries at work: causes, spectrum and management. Int J Res Med Sci. 2023;10(1):750-9. DOI: https://doi.org/10.52403/ijrr.20230187
Lahiri A. Guidelines for management of crush injuries of the hand. J Clin Orthop Trauma. 2020;11:S96-102. DOI: https://doi.org/10.1016/j.jcot.2020.03.028
Güntürk ÖB, Karalezli N, Çelik M. Reconstruction of mutilating hand injuries by microsurgical free tissue transfers from the foot. Injury. 2021;52(6). DOI: https://doi.org/10.1016/j.injury.2021.03.044
Alexandrov A, Petrova D, Ivanov K. Local, regional and distant flaps in reconstructive hand surgery in children. Issues Reconstr Plast Surg. 2022;25(1). DOI: https://doi.org/10.52581/1814-1471/80/01
Karim-Zade GD, Rahimi H, Momeni A. Outcomes of forearm flap applications in severe upper limb injuries reconstruction. Avicenna Bull. 2021. Available at: https://vestnik-avicenna.tj/en/archive/ 2021/3/the-outcomes-of-the-forearm-flap-applications-in-the-upper-limb-severe-injuries-reconstruction/. Accessed on 06 October 2025.
Valeev MM, Karimov RR, Khamidullin ZR. Microsurgery techniques for patients with traumatic thumb amputation. Creative Surg Oncol. 2019;9(1). DOI: https://doi.org/10.24060/2076-3093-2019-9-1-44-49
Choughri H, Weigert R, Heron A, Dahmam A, Abi-Chahla ML, Delgove A. Indications and functional outcome of the use of integra® dermal regeneration template for the management of traumatic soft tissue defects on dorsal hand, fingers and thumb. Arch Orthop Trauma Surg. 2020;140(12):2115-27. DOI: https://doi.org/10.1007/s00402-020-03615-z
Malikov M, Ismailov A, Rasulov R. Delayed reconstructive surgery for severe hand injuries. Avicenna Bull. 2022. Available at: https://vestnik-avicenna.tj/en/archive/2022/2022-3/delayed-reconstructive-surgery-for-severe-hand-injuries/. Accessed on 06 October 2025.
Jabre S, El Hage R, Khalil R. Comprehensive reconstruction and rehabilitation of explosive hand trauma: a case report. Int J Res Med Sci. 2025;11(3):616-9. DOI: https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251144
Khan M, Ali S, Raza A. Reconstruction of soft tissue defects of the hand: a systematic approach. Pak J Med Sci. 2023;39(4). DOI: https://doi.org/10.12669/pjms.40.1.7484
Das De S. The Role of Microsurgery in Coverage of Defects of the Hand. Hand Clin. 2024;40(2):221-8. DOI: https://doi.org/10.1016/j.hcl.2023.10.003
