Staged Reconstruction of Severe Post-Crush Hand Injury Using Scip Free Flap And Adjunctive Lipofilling: A Care-Compliant Case Report

Background: Severe crush injuries of the hand represent a major reconstructive challenge due to extensive skeletal, articular, neurovascular, and soft-tissue damage. Secondary complications, including scar contractures, joint stiffness, and functional limitations, frequently require multiple surgical interventions and prolonged rehabilitation. Staged reconstruction combining microsurgical techniques and autologous fat grafting may contribute to functional recovery. Aim: To report a case of severe occupational crush injury of the hand managed through staged reconstruction, highlighting the surgical procedures, use of a superficial circumflex iliac artery perforator (SCIP) free flap, adjunctive autologous fat grafting, and postoperative functional outcomes. Method: A descriptive single-patient case report based on retrospective analysis of medical records, surgical procedures, postoperative assessments, imaging studies, and rehabilitation outcomes. The report was prepared in accordance with the CARE guidelines, with additional consideration of the SCARE recommendations for surgical case reporting. Results: A 42-year-old man sustained a severe occupational crush injury to the right hand, resulting in multiple fractures, carpal and carpometacarpal dislocations, neurovascular injuries, and extensive soft-tissue damage. Initial treatment included surgical debridement, fracture reduction, and stabilization with Kirschner wires. Subsequently, hypertrophic and retractile scars, joint stiffness, sensory disturbances, and restricted finger extension developed. Two sessions of autologous fat grafting were performed in April and July 2025, with 12 mL injected per procedure. Persistent functional limitations required extensive scar release, adhesiolysis, neurolysis, and reconstruction with a 15 × 6 cm SCIP free flap in October 2025. The flap remained viable, with progressive improvement in range of motion and hand function following rehabilitation. In May 2026, secondary flap debulking and additional fat grafting were performed to improve contour and symmetry. No acute complications were documented following the final procedure. Conclusion: Severe hand crush injuries may require individualized, sequential reconstruction to address complex anatomical damage and functional sequelae. This case demonstrates that the integration of skeletal stabilization, scar management, autologous fat grafting, SCIP free-flap reconstruction, and rehabilitation can provide sustained soft-tissue coverage and progressive functional improvement. Secondary refinement procedures may be necessary to optimize reconstructive outcomes.