Refinements in hand coverage with microvascular free flaps.

The specialized tissue requirements or dorsal and palmar skin are analyzed and options for full-thickness replacement outlined in detail. Thoughtful and accurate preoperative planning is the key to success. Dorsal coverage with a variety of pedicled and free fasciocutaneous flaps are quite satisfactory. Palmar coverage is more difficult and the need for sensation more critical. Free vascularized temporoparietal fascial flaps covered with full-thickness skin grafts are currently the treatment of choice for most complex wounds.