The Hand Surgery Landscape|Articles in Press

Soft Tissue Management of Partial Hand Amputation

Published:March 07, 2023DOI:
      Conventional teaching in the management of partial hand amputations prioritizes residual limb length, often through local, regional, or distant flaps. While multiple options exist to provide durable soft tissue coverage, only a few flaps are thin and pliable enough to match that of the dorsal hand skin. Despite debulking, excessive soft tissues from previous flap reconstructions can interfere with residual limb function, prosthesis fit, and surface electrode recording for myoelectric prostheses. With rapid advances in prosthetic technology and nerve transfer techniques, patients can achieve very high levels of function following prosthetic rehabilitation that rival, or even outpace, traditional soft tissue reconstruction. Therefore, our reconstruction algorithm for partial hand amputations has evolved to the thinnest coverage possible, providing adequate durability. This evolution has provided our patients with faster and more secure prosthesis fitting with better surface electrode detection, enabling earlier and improved use of simple and advanced partial hand prostheses.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baccarani A.
        • Follmar K.E.
        • de Santis G.
        • et al.
        Free vascularized tissue transfer to preserve upper extremity amputation levels.
        Plast Reconstr Surg. 2007; 120: 971-981
        • Marchessault J.A.
        • McKay P.L.
        • Hammert W.C.
        Management of upper limb amputations.
        J Hand Surg Am. 2011; 36: 1718-1726
        • Tintle S.M.
        • Baechler M.F.
        • Nanos G.P.
        • Forsberg J.A.
        • Potter B.K.
        Traumatic and trauma-related amputations: Part II: Upper extremity and future directions.
        J Bone Joint Surg Am. 2010; 92: 2934-2945
        • Wang H.T.
        • Erdmann D.
        • Fletcher J.W.
        • Levin L.S.
        Anterolateral thigh flap technique in hand and upper extremity reconstruction.
        Tech Hand Up Extrem Surg. 2004; 8: 257-261
        • Lister G.D.
        • McGregor I.A.
        • Jackson I.T.
        The groin flap in hand injuries.
        Injury. 1973; 4: 229-239
        • Parrett B.M.
        • Bou-Merhi J.S.
        • Buntic R.F.
        • Safa B.
        • Buncke G.M.
        • Brooks D.
        Refining outcomes in dorsal hand coverage: consideration of aesthetics and donor-site morbidity.
        Plast Reconstr Surg. 2010; 126: 1630-1638
        • Pierrie S.N.
        • Gaston R.G.
        • Loeffler B.J.
        Targeted muscle reinnervation for prosthesis optimization and neuroma management in the setting of transradial amputation.
        J Hand Surg Am. 2019; 44: 525.e1-525.e8
        • Gart M.S.
        • Souza J.M.
        • Dumanian G.A.
        Targeted muscle reinnervation in the upper extremity amputee: a technical roadmap.
        J Hand Surg Am. 2015; 40: 1877-1888
        • O’Shaughnessy K.D.
        • Dumanian G.A.
        • Lipschutz R.D.
        • Miller L.A.
        • Stubblefield K.
        • Kuiken T.A.
        Targeted reinnervation to improve prosthesis control in transhumeral amputees. A report of three cases.
        J Bone Joint Surg Am. 2008; 90: 393-400
        • Gaston R.G.
        • Bracey J.W.
        • Tait M.A.
        • Loeffler B.J.
        A novel muscle transfer for independent digital control of a myoelectric prosthesis: the starfish procedure.
        J Hand Surg Am. 2019; 44: 163.e1-163.e5
        • Han T.
        • Khavanin N.
        • Wu J.
        • et al.
        Indocyanine green angiography predicts tissue necrosis more accurately than thermal imaging and near-infrared spectroscopy in a rat perforator flap model.
        Plast Reconstr Surg. 2020; 146: 1044-1054
        • Yannascoli S.M.
        • Thibaudeau S.
        • Levin L.S.
        Management of soft tissue defects of the hand.
        J Hand Surg Am. 2015; 40: 1237-1245
        • Upton J.
        • Rogers C.
        • Durham-Smith G.
        • Swartz W.M.
        Clinical applications of free temporoparietal flaps in hand reconstruction.
        J Hand Surg Am. 1986; 11: 475-483
        • Ritz M.
        • Mahendru S.
        • Somia N.
        • Pacifico M.D.
        The dorsalis pedis fascial flap.
        J Reconstr Microsurg. 2009; 25: 313-317
        • McGregor I.A.
        • Jackson I.T.
        The groin flap.
        Br J Plast Surg. 1972; 25: 3-16
        • Rehim S.A.
        • Singhal M.
        • Chung K.C.
        Dermal skin substitutes for upper limb reconstruction: Current status, indications, and contraindications.
        Hand Clin. 2014; 30 (vii): 239
        • Reynolds M.
        • Kelly D.A.
        • Walker N.J.
        • Crantford C.
        • Defranzo A.J.
        Use of Integra in the management of complex hand wounds from cancer resection and nonburn trauma.
        Hand (N Y). 2018; 13: 74-79
        • Hamdan A.M.
        • Al-Chalabi M.M.M.
        • Wan Sulaiman W.A.
        Integra: an alternative option for reconstruction of extensive finger defects with exposed bones.
        Cureus. 2021; 13e16223
        • Zhu B.
        • Cao D.
        • Xie J.
        • Li H.
        • Chen Z.
        • Bao Q.
        Clinical experience of the use of Integra in combination with negative pressure wound therapy: an alternative method for the management of wounds with exposed bone or tendon.
        J Plast Surg Hand Surg. 2021; 55: 1-5
        • Yamada N.
        • Ui K.
        • Uchinuma E.
        The use of a thin abdominal flap in degloving finger injuries.
        Br J Plast Surg. 2001; 54: 434-438
        • Jabaiti S.
        • Ahmad M.
        • AlRyalat S.A.
        Reconstruction of upper extremity defects by random pedicle abdominal flaps: is it still a valid option?.
        Plast Reconstr Surg Glob Open. 2020; 8: e2687
        • Koshima I.
        • Moriguchi T.
        • Etoh H.
        • Tsuda K.
        • Tanaka H.
        The radial artery perforator-based adipofascial flap for dorsal hand coverage.
        Ann Plast Surg. 1995; 35: 474-479
        • Xie R.G.
        • Gu J.H.
        • Gong Y.P.
        • Tang J.B.
        Medial sural artery perforator flap for repair of the hand.
        J Hand Surg Eur Vol. 2007; 32: 512-517
        • Urushidate S.
        • Yotsuyanagi T.
        • Yamauchi M.
        • et al.
        Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers.
        J Plast Reconstr Aesthet Surg. 2010; 63: 693-699
        • Liu Y.
        • Song B.
        • Zhu S.
        • Jin J.
        Reconstruction of the burned hand using a super-thin abdominal flap, with donor-site closure by an island deep inferior epigastric perforator flap.
        J Plast Reconstr Aesthet Surg. 2010; 63: e265-e268
        • Herter F.
        • Ninkovic M.
        • Ninkovic M.
        Rational flap selection and timing for coverage of complex upper extremity trauma.
        J Plast Reconstr Aesthet Surg. 2007; 60: 760-768
        • Ho T.
        • Couch M.
        • Carson K.
        • Schimberg A.
        • Manley K.
        • Byrne P.J.
        Radial forearm free flap donor site outcomes comparison by closure methods.
        Otolaryngol Head Neck Surg. 2006; 134: 309-315
        • Brown M.T.
        • Couch M.E.
        • Huchton D.M.
        Assessment of donor-site functional morbidity from radial forearm fasciocutaneous free flap harvest.
        Arch Otolaryngol Head Neck Surg. 1999; 125: 1371-1374
        • Chen Y.C.
        • Scaglioni M.F.
        • Carrillo Jimenez L.E.
        • Yang J.C.S.
        • Huang E.Y.
        • Lin T.S.
        Suprafascial anterolateral thigh flap harvest: a better way to minimize donor-site morbidity in head and neck reconstruction.
        Plast Reconstr Surg. 2016; 138: 689-698
        • Dibbs R.
        • Grome L.
        • Pederson W.C.
        Free tissue transfer for upper extremity reconstruction.
        Semin Plast Surg. 2019; 33: 17-23
        • Brent B.
        • Upton J.
        • Acland R.D.
        • et al.
        Experience with the temporoparietal fascial free flap.
        Plast Reconstr Surg. 1985; 76: 177-188
        • Hing D.N.
        • Buncke H.J.
        • Alpert B.S.
        Use of the temporoparietal free fascial flap in the upper extremity.
        Plast Reconstr Surg. 1988; 81: 534-544