This is a 30-year review of 60 patients with hand and wrist soft-tissue defects secondary to trauma, contracture release, congenital deformity, thermal injury, and vascular malformation corrections treated with fascial flaps and combinations of different sources of skin grafts to provide think coverage which minimizes tendon adhesion. Patients were pediatric and adult and the most common flap used was the free temporoparietal fascial flap followed by the radial forearm fascial flap, first dorsal metacarpal artery fascial flap, and tensor fasciae latae flap.
Results showed that there were no flap losses and patients started aggressive hand therapy approximately 3 weeks postoperatively after strict immobilization. The most common complication was scar alopecia at temporoparietal fascial flap harvest sites. Functional results and cosmesis were judged excellent but no objective scale or comparison to other types of coverage was made for direct comparison. However, a review of multiple case series involving different flap types is offered with comparisons of flap dimensions, sensibility, advantages, and disadvantages. The article offers 9 “lessons learned” through the author senior author’s extensive 30-year experience and provides several excellent options for coverage of difficult soft tissue defects.