Reconstruction of the hand by free tissue transfer

The development of free tissue transfer has made possible the reconstruction of severely damaged hands and the replacement of fingers and thumbs. In this connection, the foot has become very important as a donor area. Because of its anatomical similarity and the ideal situation of the dorsalis pedis artery, a great variety of transplants can be made as circumstances demand. The cases illustrated show the possibilities of providing sensitive skin cover, and reconstruction by combined tissue transfer such as flap with bone, or flap with tendon and toe or two-toe en-bloc transplantation. Operation is comparatively safe - in this series of 56 cases, the success rate was 92.8%. Functional and cosmetic results are good. Problems with the secondary defect in the foot are acceptable and can mostly be solved.