How it works
Everything begins with a consultation. Your surgeon will look at the defect directly, noting where it is, how wide and deep it is, and whether tendon, joint, or bone is exposed, and will assess your hand's movement, sensation, and blood supply. Your surgeon will also ask about your medical history, how the injury happened, any underlying conditions, and the kind of work you do. Sometimes blood tests, a wound culture, or an X-ray are needed to see the structures underneath more clearly.
Before coverage, your surgeon usually cleans the wound and removes any dead or infected tissue so that only a healthy tissue bed remains. This step may be done at the same time as coverage or as a separate procedure beforehand. A clean bed with a good blood supply is what allows the coverage to take and heal.
The surgery may be done under regional anesthesia (your whole arm is numbed while you stay awake) or general anesthesia (you are fully asleep for the entire operation); the exact type is decided by your anesthesiologist based on the extent of surgery and your health. To cover the area, your surgeon chooses the approach that suits the depth and location of the injury: a skin graft (taking a thin piece of skin from another area and laying it over the wound) when the injury is shallow and the bed underneath nourishes it well; or a tissue flap, rotating, sliding, or moving a section of skin, fat, and sometimes fascia or muscle from a nearby area or elsewhere on the body to fill the gap, when the injury is deeper or tendon or bone is already exposed. The technique is chosen hand by hand.
After coverage, your surgeon closes the surgical site, applies a dressing, and usually places a splint to hold your hand in a protected position during the early healing phase. If a skin graft or a flap is taken from another part of your body, that donor area is also stitched or covered and will leave a scar.