Outcomes of Thin Groin Flaps for Hand and Finger Reconstruction: A Mixed Retrospective-Prospective Study

Introduction Reconstruction of soft tissue defects in the hand and fingers remains challenging, particularly in complex injuries. The thin groin flap, a pedicled flap technique, offers a reliable option for coverage with acceptable functional and aesthetic outcomes. Objective The objective of the study is to evaluate the clinical and functional outcomes of thin groin flap reconstruction for hand defects. Methods This was a mixed retrospective-prospective study conducted in government and private hospitals in Sana'a, Yemen (Typical Police Hospital and Elite Hospital), which have reconstructive surgery units from January 2021 to December 2024. Outcomes assessed included flap healing time, operation duration, Disabilities of the Arm, Shoulder, and Hand (DASH) scores at one month, complication rates, and patient satisfaction. A subgroup analysis evaluated the impact of using magnification loupes during surgery. Results This study involved 25 patients; the median age was 27.0 years (interquartile range (IQR) 22.0-40.0) with a slight male predominance (14, 56.0%). Primary causes of injury were non-gunshot trauma (10, 40.0%), burns (10, 40.0%), and high-energy gunshot injuries (4, 16.0%). The median defect size was 7.0 cm² (IQR 6.0-7.0), and the median time from injury to surgery was 7.0 days (IQR 5.0-16.0). Surgical magnification loupes were used in 22 (88.0%) of procedures. A complete flap survival rate of 24 (96.0%) was achieved, with an overall success rate of 20 (80.0%). Functional outcomes, assessed by the DASH score, were generally favorable (median 10.0, IQR 5.0-25.0). Surgical magnification loupes significantly improved outcomes, reducing complication rates (9.1% (n = 2) vs. 100.0% (n = 3) in the no-loupe group (Fisher's exact test, p = 0.028)), improving functional scores (median DASH 10.0 vs. 50.0 (Mann-Whitney U = 0.0, p = 0.018)), and shortening hospital stays (median 4.5 days vs. 15.0 days; p = 0.004). Predictors of poorer functional outcomes included gunshot wounds, associated injuries, longer time from injury to surgery, and larger defect size. Conclusion The study concludes that thin groin flaps are a reliable option for hand reconstruction, with surgical magnification significantly enhancing outcomes and patient recovery.