Simple Reconstructive Techniques for Management of Complex Hand Injuries: Prospective study.

Background: Complex hand injuries frequently involve soft-tissue loss with exposure of bone and tendons, requiring stable coverage and preservation of motion and sensibility. Although free flaps are invaluable for extensive composite defects, they are resource-intensive and may not be necessary for moderate-sized injuries. Aim: To evaluate clinical, functional, sensory, and patient-reported outcomes of simple reconstructive techniques for complex hand injuries and to identify factors associated with better functional recovery. Patients and Methods: This prospective series included 30 patients with complex hand soft-tissue defects managed using local and regional flaps or skin grafts. Outcomes were assessed using range of motion (ROM), two-point discrimination (2PD), Semmes–Weinstein monofilament testing, Disabilities of the Arm, Shoulder and Hand (DASH) scores (pre- and post-operative), visual analogue scale (VAS) for pain, satisfaction score, time to return to work, and correlation analyses. Results: The cohort had a mean age of 35.1 years, with females representing 56.7%. Most patients were right-hand dominant (53.3%), and half of the injuries involved the dominant hand. Defects averaged 3.04 cm², and 80% showed bone or tendon exposure. V-Y flaps were the most common technique (20%), with other local and regional flaps used as needed. Mean operative time was 60 minutes, blood loss 100 mL, and healing time 36.5 days; 70% of patients had no complications, and return-to-work averaged 3.5 weeks. Conclusion: In carefully selected complex hand injuries with moderate-sized defects and frequent tendon or bone exposure, simple local and regional techniques