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Colen, Jason Wink and Anthony Archual  \nReceived: 28 September 2025  \nRevised: 10 December 2025  \nAccepted: 17 December 2025  \nPublished: 19 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Plastic and Hand Surgery, St. Hedwig of Silesia Hospital, 55-100 Trzebnica, Poland  \n2 Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland  \n3 Youthoria, Youth Research Organization, 30-363 Krakow, Poland  \n4 Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland  \n* [Correspondence: pawel.poznanski@pwr.edu.pl](Correspondence: pawel.poznanski@pwr.edu.pl)  \nAbstract  \nBackground/Objectives: The goal of reconstructive hand surgery is to achieve both functional and aesthetic restoration. The primary aim of this study is to perform a detailed, practice-oriented evaluation of perforator-based and local flaps for soft-tissue reconstruction of the hand and digits, focusing specifically on their functional reliability, anatomical consistency, complication profile, and aesthetic integration in a real-world, high-complexity referral population. Methods: This retrospective single-center study included 37 patients with soft tissue defects of the hand that required flap coverage between September 2021 and September 2024 . The study assessed patient demographics, defect characteristics, flap selection, surgical techniques, and outcomes including satisfactory soft tissue coverage, functional results and occurrence of complications. Various perforator flaps were analyzed, including the dorsal metacarpal artery flap, reverse radial forearm flap, reverse posterior interosseous artery flap, reverse homodigital and heterodigital island flaps, and the thenar flap. Results: Satisfactory soft tissue coverage was achieved in 35 out of 37 patients. One case involved partial distal flap necrosis, and another presented with Foucher flap failure. The remaining flaps demonstrated stable integration, preserved perfusion, and durable soft-tissue coverage with satisfactory contour and pliability. Functional outcomes were favorable, with restoration of joint mobility and absence of secondary deformities. Conclusions: This study supports the continued use of perforator and local flaps in upper extremity reconstruction, emphasizing the need for individualized planning to optimize the outcomes.  \nKeywords: perforator flaps; thenar flap; reconstruction; upper limb  \n1. Introduction  \nThe primary objective of reconstructive hand surgery is the restoration of function while maintaining an aesthetically acceptable appearance. The hand is a highly visible and functionally complex organ, making both aspects equally important [1] . Despite significant advancements in microsurgical techniques, an optimal strategy for soft tissue coverage remains a subject of discussion. The literature has extensively documented various flap techniques; however, there is still an ongoing debate regarding the ideal balance between function, aesthetic outcomes, and donor-site morbidity [2–4] .  \nA systematic approach to hand defect coverage begins with thorough wound debridement, performed under tourniquet control to ensure the removal of all nonviable  \ntissues while preserving vital structures. Once debridement is complete, the reconstructive ladder concept helps guide the decision-making process, categorizing defects into those that are simple, suitable for direct closure, skin grafting, the use of a dermal","cbCaibYglR67Um4f","https://ap.wps.com/l/cbCaibYglR67Um4f","pdf",4261617,14,"English","# Introduction\n## Reconstructive objective and ongoing debate\n## Systematic approach: debridement and reconstructive ladder\n## Rationale for perforator-based and local flaps\n# Materials and Methods\n## Patient selection and study design\n## Inclusion criteria and follow-up","[{\"question\":\"What was the primary aim of this study on hand soft-tissue reconstruction?\",\"answer\":\"To provide a detailed, practice-oriented evaluation of perforator-based and local flaps for soft-tissue reconstruction of the hand and digits, emphasizing functional reliability, anatomical consistency, complication profile, and aesthetic integration.\"},{\"question\":\"How many patients and what type of defects were included?\",\"answer\":\"The retrospective single-center study included 37 patients with soft tissue defects of the hand requiring flap coverage between September 2021 and September 2024.\"},{\"question\":\"What were the main outcomes regarding soft-tissue coverage and function?\",\"answer\":\"Satisfactory soft-tissue coverage was achieved in 35 of 37 patients. Functional outcomes were favorable, with restoration of joint mobility and absence of secondary deformities, while complications were limited to specific flap failures.\"}]","Considerations in Flap Selection for Soft Tissue Coverage of the Hand and Digits | PDF",1790761644,35]