Dorsal Hand Reconstruction with Web Contracture Release Using Free Superficial Inferior Epigastric Artery Flap

Abstract

Summary:. We present a case in which reconstruction of the dorsum of the hand and finger web space was carried out concurrently with the insertion of a superficial inferior epigastric artery flap into the interdigital spaces. This approach was taken to prevent the potential development of subsequent web space contracture. The patient, a 57-year-old woman, presented with a necrotizing soft tissue infection on the dorsum of her left hand, resulting in a full-thickness skin defect extending from the metacarpophalangeal joint to the wrist, with exposure of the extensor tendons. The reconstructive surgery involved raising a superficial inferior epigastric artery flap and transplanting it onto the tissue defect, to cover not only the dorsal defect but also the interdigital spaces after releasing web space contracture. Consequently, the surgery successfully released scar contractures on the dorsum of the hand and provided adequate interdigital space formation without requiring additional procedures, except defatting. At the 7-month postoperative follow-up, the patient had a good outcome with shoulder and hand (Quick Disabilities of Arm, Shoulder and Hand) score of 28.9 points. Interdigital scar contractures often lead to decreased fine motor skills and functional impairment, affect aesthetics, and require a prolonged period for social reintegration. This surgical technique involves simultaneous one-stage closure of the dorsal defect with a flap and interdigital reconstruction to prevent future scar contractures and functional impairments, and is a valuable approach for shortening the treatment duration.