Digital reconstruction in the mutilated hand.

Salvage and reconstruction of the mutilated degloved hand or digit pose a problem because of the deficiency of local innervated pulp tissue. Free neurovascular flaps from the first web space of the foot supply a large area of well-padded innervated glabrous skin to resurface such defects. In thumb reconstruction free flaps, which may include the toenail, have many advantages over the conventional ring-finger island flap. Finger and whole-toe transfers are innervated reconstruction par excellence and these, in combination with innervated free flaps, offer a large armamentarium for reconstruction. The quality of sensation, however, is poorer than normal in these transfers and they are therefore limited to circumstances in which their use is not substituted by adjacent normal units.