Immediate Reconstruction of Complex Hand Trauma With Iliac Crest Bone Graft and 2 Pedicled Fasciocutaneous Skin Flaps: A Case Report

Objective: The decision about primary or staged reconstruction of all structures in severe hand injuries is controversial. The purpose of this case report is to present a surgical protocol that lead to good functional results and rapid recovery after primary bone grafting with pedicled flap coverage of a complex hand injury. Methods: A case is reported in which 2 iliac crest bone grafts, an extended dorsal metacarpal artery flap and a heterodigital island flap, were performed at primary intervention to reconstruct the index and middle fingers of a 17-year-old patient. Results: Length and sensation of the digits were fully preserved while the destroyed joints were fused and covered with mobile soft tissue. Hereby, a satisfactory pinch grip and hand closure was restored, allowing the patient to return to work after only 2 months. Conclusions: Given proper planning and adequate debridement, primary reconstruction of all injured structures should be considered when dealing with complex hand injuries.