A 42-year-old patient suffered a complete loss of soft tissue coverage
over the carpus and metacarpus of her dominant hand. With exposure of
vessels and nerves, and an open joint dislocation and finger amputati
ons, immediate cover of the circumferential defect was achieved using
a free rectus abdominis muscle flap covered with a skin graft. Healing
was uneventful, and the flap bulkiness decreased within one-half year
; debulking was not required. The final hand function was excellent. E
mergency free flap coverage can salvage a hand; the rectus abdominis m
uscle flap transfer is safe, technically easy and expendable.