Radial forearm snake flap for the reconstruction of a hand defect

Skin grafts may not always be possible for deep hand burns due to a possible exposure of tendons, ligaments, joints, nerves, vessels, and bones. Therefore, a free tissue transfer is required in complex cases. We present a case of a 72-year-old man with a fire burn injury to the dorsum of the hand and first and second fingers. The necrotic areas were debrided, and wide defect with exposed extensor tendons was covered with the serratus anterior-free fascia flap and split-thickness skin graft. Partial necrosis was developed. The exposed second metacarpophalangeal joint, proximal and middle phalanx was reconstructed with our long and narrow radial forearm-free flap (RFFF) design. The patient had no complications and was referred to physical therapy. Free tissue transfers in burn injuries are usually utilized in extensive defects. However, narrow defects that cannot be readily covered with adjacent tissue present unique challenges. Our long and narrow RFFF design can be a new and reliable option in these circumstances.