Serratus fascia "sandwich" free-tissue transfer for complex dorsal hand and wrist avulsion injuries

The serratus anterior fascia was used as a free-tissue transfer in four pat ients for the reconstruction of dorsal hand defects. Ail patients had multi ple open metacarpal fractures with extensor tendon injuries. The fascia was used to "sandwich" the extensor tendons ina bed of areolar gliding tissue to avoid adhesions. The mean follow-up was 2 years. There were no complicat ions and all flaps survived completely. All flaps were grafted with meshed split-thickness skin at the time of transfer with a 100 percent take in ail cases. A good functional result was noted in all patients. This free-tissu e transfer is recommended for complex injuries to the dorsum of the hand as sociated with soft-tissue defects.