Dorsal digitial dilemma

[pjt]

For full-thickness burns of the dorsum of the digits, where a skin graft, would most likely not take, what are people's recommendations for coverage? I'm hesitiant to uses volar skin and hesitant to use small complex axial flaps in the hand.

[dr_scalpel]

In our department we had a similar case, a patient sustained crushing injury of the index, middle, and ring finger with third degree burn of the dorsal skin. Covering of these fingers with Dorsal metacarpal artery flap is critical as the extension of the thermal injury may cause damage of the pedicle. the best option for these patients is to cover the defect with a thin free flap like temporalis fascia flap.

[albcohn]

Depending on the extent/location of the defect, another option to consider is a pedicled reverse radial forearm flap. I've seen it using fascia ONLY (skin-sparing) for this type of injury with a thin graft placed over the flap. It worked well.