Flap Resurfacing of Postinfection Soft-Tissue Defects of the Hand

BACKGROUND: Severe suppurative infections of the hand require antibiotics and excisional debridement for control and reversal. This sometimes results in large soft-tissue defects for which primary closure may not be possible. METHODS: Thirty-one patients had postinfection soft-tissue defects of the hand that were resurfaced using flaps. Small defects (<5 cm in greatest dimension) were found in 22 patients, medium-sized defects (5 to 10 cm in greatest dimension) were found in four patients, and large defects (>10 cm in greatest dimension) were found in five patients. Type 2 diabetes mellitus was present in 48 percent. RESULTS: Flap survival was 100 percent. There was no flap necrosis or reactivation of infection. Patients regained functional use of the hand, and employed patients returned to work. CONCLUSIONS: Provided that infections have been well controlled by judicious surgical debridement and appropriate flap selection and technique is exercised, flap resurfacing can be performed safely and remains an important adjunct in the total management of hand infections. Benefits include the provision of a durable vascularized wound bed, which facilitates primary healing, restoration of gliding planes for exposed tendons and neurovascular structures, and provision of a stable platform for early mobilization and support of future reconstructive efforts if these are required.