Repair of a Large Dorsal Hand Defect After Mohs Micrographic Surgery

Double V-Y Island Pedicle Flap for Dorsal Hand Reconstruction Following Mohs Micrographic Surgery

Medium to large defects on the dorsal hand pose a reconstructive challenge following dermatologic surgery. Repairs in this location can be complicated by a paucity of adjacent tissue reservoirs, competing tension vectors, thin cutaneous tissue, and superficial tendons and vasculature. In such cases, a double V-Y island pedicle flap is an effective reconstructive solution. It preserves hand function, harnesses local tissue with a robust blood supply, facilitates complete closure, and provides skin that closely matches the original's color and texture. Here, we present the repair of a medium to large dorsal hand defect after Mohs micrographic surgery for melanoma in situ, using a double V-Y island pedicle flap.

Reconstructive options for cutaneous dorsal hand defects

BACKGROUND

Moderate to large dorsal hand defects pose reconstructive challenges owing to the small surface area, immobile adjacent finger tissue, and thin, fragile skin.

OBJECTIVE

To present reconstructive options for moderate to large dorsal hand defects.

MATERIALS AND METHODS

First, a brief review of dorsal hand reconstructive options is discussed. Then, three approaches to reconstructing dorsal hand defects are presented based on the amount of available underlying tissue and location of the defect on the hand.

RESULTS

In the authors' opinion, for larger defects on the mid-distal 1st-3rd metacarpals, the single arm rotation flap is preferable. For medium-sized defects with underlying soft tissue, a Burow's graft is appropriate. The O-Z flap is best for medium- to large-sized defects on the proximal half of the metacarpals. Defects of the digits are excluded.

CONCLUSION

The O-Z rotation flap, single arm rotation flap, or Burow's graft can be used to reconstruct the majority of moderate to large dorsal hand defects.