A treatment algorithm for reconstruction of soft tissue defects in the hand: a narrative review

BACKGROUND AND OBJECTIVE: The hand is the highly specialized distal construct of the upper limb with complex and intricate anatomy. Soft tissue defects can compromise this and result in significant functional impairment. Choosing the optimal reconstructive modality is essential for the best functional recovery. The objective of this narrative review was to provide a treatment algorithm for soft tissue defects in the hand. METHODS: Relevant literature for the topic was searched from PubMed and Cochrane Database from year 1953 up till end of November 2022. Specified searches for randomized controlled trials, systematic reviews and reviews were performed. KEY CONTENT AND FINDINGS: There are no randomized controlled trials published on this topic. There are six systematic reviews or meta-analyses published. Most of the literature still comprises on expert opinion and case reports with few previously proposed algorithms. Defect features, size, location and depth, patient related factors and available resources are the main determinants of the treatment strategy. In the hand, there are reasonable locoregional coverage options, but microsurgical options should be a routine alternative of the treatment repertoire. In the thumb and fingers, the reconstruction depends remarkably on injury extent. CONCLUSIONS: Patient factors, surgical expertise, etiology, severity and goal of reconstruction will invariably have influence on the ultimate reconstruction performed, and algorithms may significantly help the surgical planning.