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 patients for the reconstruction of dorsal hand defects. All patients had multiple open metacarpal fractures with extensor tendon injuries. The fascia was used to "sandwich" the extensor tendons in a bed of areolar gliding tissue to avoid adhesions. The mean follow-up was 2 years. There were no complications 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 all cases. A good functional result was noted in all patients. This free-tissue transfer is recommended for complex injuries to the dorsum of the hand associated with soft-tissue defects.