Flap reconstruction versus dermal regeneration template for finger soft-tissue defects: comparative clinical outcomes

Finger soft-tissue defects require thin, pliable, and durable coverage that preserves tendon gliding and hand function. Flap reconstruction remains the standard approach, providing well-vascularized tissue and reliable single-stage coverage, but is associated with donor-site morbidity and technical complexity. These limitations have prompted the search for alternative reconstructive strategies. Dermal regeneration templates (DRTs) have emerged as a potential option; however, comparative data evaluating their functional performance in finger defects remain limited. This study aimed to compare DRT-based reconstruction with flap surgery using standardized clinical and functional outcomes. A retrospective comparative study was conducted including 99 fingers from 89 patients with isolated finger soft-tissue defects treated between May 2020 and October 2022. Patients underwent either flap reconstruction ( n = 47) or DRT-based reconstruction ( n = 52). Functional and clinical outcomes, including total active motion (TAM), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, key pinch strength (KPS), scar quality (Vancouver Scar Scale, VSS), operative time, and complications, were evaluated. Multivariable regression analyses were performed to assess the independent effect of treatment modality. Additional patient-level sensitivity and cluster-adjusted analyses were conducted to account for potential within-patient correlation. Flap reconstruction resulted in significantly higher TAM (210.0 ± 26.0° vs. 192.2 ± 22.6°, p < 0.001) and lower QuickDASH scores (12.64 ± 8.41 vs. 21.77 ± 8.41, p < 0.001) compared with DRT. These differences remained significant after adjustment for confounders and remained robust in patient-level sensitivity and cluster-adjusted analyses. DRT-based reconstruction was associated with significantly shorter operative time (25 (15–40) vs. 60 (40–80) min, p < 0.001). Additional split-thickness skin grafting was required more frequently in the DRT group than in the flap group (78.8% vs. 51.1%, p = 0.004). No significant differences were observed between groups in KPS or major complication rates, while VSS showed a non-significant trend toward better scar quality in the DRT group. Treatment modality was not a significant predictor of major complications. Defect size was not independently associated with clinical outcomes. Flap reconstruction provides superior functional outcomes in terms of joint motion and disability scores in finger soft-tissue defects, whereas the DRT product used in this cohort may represent a flap-harvest–sparing alternative with shorter operative time and favorable scar characteristics in selected cases. Treatment selection should be individualized based on functional demands and clinical priorities. Level III, retrospective comparative study.