Free and island flap transfer for soft tissue defects in the hand and forearm.

Two hundred twenty patients with soft tissue defects in the hand and forearm were treated with 226 free and island flap transfers. Reconstructed sites involved the thumb in 74 cases, the fingers in 117, the hand in 30, and the forearm in 5. Seventy-nine patients received 82 free flaps, and 141 patients received 144 island flaps. Fifty-six finger reconstruction cases and 73 of 74 thumb reconstruction cases had sensory flap transfers. In the free flap transfer group, 77 flaps survived (93.9%), and 5 failed. In the island flap transfer group, 140 flaps survived (97.2%), and 4 failed. Of the five-failures in the free flap transfers, four were dorsalis pedis flaps, two of which were on patients with an arteriovenous fistula. Of the four failures in the island flap transfers, two were posterior interosseous flaps and two were digital island flaps. All four were reverse-flow island flaps.