Abdominal Pedicled Flap: Alternative for Hand Reconstruction When Microsurgery Is Not an Option

Soft tissue defects of the dorsal hand, especially overlying tendons and other important structures, can prove to be a reconstructive challenge; though microsurgical free flaps are considered the gold standard, the lack of resources often necessitates alternative approaches. A 74-year-old male patient presented with dorsal hand loss caused by skin infection and abscess formation after prolonged use of an antebrachiopalmar splint, resulting in an 18 cm × 12 cm defect with tendon exposure and fibrin deposition. A random-pattern pedicled abdominal flap harvested from the infraumbilical right lower abdominal quadrant was transposed to the defect and secured with simple nylon 3-0 sutures, while the donor site was primarily closed. Complete functional recovery without complications was achieved after pedicle division at three weeks. Random-pattern pedicled abdominal flaps should thus be regarded as a valuable staple in upper extremity reconstruction, particularly when microsurgery is not feasible.