الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
There is a large number of insults that can compromise the soft tissue envelope of the hand. Hand surgeons are frequently challenged by the unique requirements of soft tissue reconstruction of the hand. Soft tissue reconstruction seeks to restore both the aesthetic appearance and the function of the hand In this study 20 patients with post-traumatic dorsal hand soft tissue defects were chosen and different reconstruction techniques were used: 1 patient with STSG, 1 patient with radial forearm flap, 13 patients with posterior interosseous artery flap, 2 patients with groin flap, 2 patients with free anterolateral thigh flap and 1 patient with free fibular osteocutaneous flap. The aim of this work is to evaluate these techniques as regards the indications, advantages and disadvantages of each technique, as well as functional outcome The age of the patients ranged from one and half years old to 62 years old. The mean age was (28.7) years.17 patients were males and 3 patients were females. 17 patients were right handed and 3 were left handed. The right hand was injured in 10 patients and the left hand was injured in 10 patients.The cause of injury in 11 cases was Road traffic accidents (RTA), Firearm injuries in 5 cases and machinery injuries in 4 cases. 14 patients had associated tendon and/or skeletal injuries and 6 patients had no associated injuries. Donor site closure was done with a STSG in 17 patients and with direct closure in 2 cases Sound coverage was achieved in all of the 20 patients. Good gliding of the underlying structures in all of the 20 patients. Restoration of the hand form was achieved in 19 patients. 2 patients had complications in the form of partial necrosis of the STSG in one patient and wound infection in another patient. Full ROM of hand joints was achieved in 13 patients. The mean quick DASH score assessed at last follow-up was 26.5. The mean score of assessment of daily activities limitation(ADL) was 4.1. The mean VAS for patients’ satisfaction was 5.7 from this study we can conclude the following Skin graft is a rapid and easy procedure for dorsal hand reconstruction. However, it can be done only if the paratenon of the extensor tendons is preserved. Regional axial flaps have many advantages including being a single stage operation, no microvascular equipment or expertise are needed, they suit elderly compromised patients and patients with coagulopathies and malignancy. Early rehabilitation can be done. However, they add to the disfigurement of the whole limb. The Radial forearm flap can cover large defects and their distal reach is up to distal interphalangeal joint of the fingers. It sacrifices a major artery and limits additional microvascular procedures. The posterior interosseous flap does not sacrifice a major vessel and can be done for medium sized defects. However, it cannot reach beyond the metacarpophalangeal joints of the fingers. The Groin flap still has a role in dorsal hand reconstruction as a backup procedure. It is a relatively simple rapid operation. Donor site can be closed primarily giving a better cosmetic appearance. Moreover, this donor site is often concealed. It has the disadvantages of being a multi-staged operation with a prolonged period of immobilization and delayed start of physiotherapy. It may need an additional debulking operation Free flaps can cover large and complex defects of the dorsum of the hand. They are a single stage operation and allow early rehabilitation.Their disadvantages are being lengthy operations and the need for certain equipment and microsurgical expertise. The Anterolateral thigh free flap provides abundant and variable tissue with good vascularity, allows a two-teams approach and has a concealed donor site. The free fibular osseocutaneous flap is a good option in case of considerable bone loss. It also has good vascularity and allows the two-teams approach.Early reconstruction and rehabilitation are essential for good post-operative functional outcome.