Background
Traumatic injuries of hand and upper extremities are common, which may pose a great challenge to reconstructive surgeons due to extensive soft tissue loss. Exposed vital structures of the digit such as bone, tendons, and nerves may require sufficient tissue coverage with tailored design. Despite current era of microsurgery and free tissue transfer as mainstay treatment, pedicle abdominal flaps still play a crucial role in hand reconstruction under certain indications. In fact, what formerly was denoted as contraindication for abdominal flaps may even be successful in specific cases. Here, we present 4 cases of finger and hand defects with bone remaining only and reconstruction with pedicled abdominal flaps.

Material and methods
A retrospective review of hand and digit full thickness skin and soft tissue defects with staged pedicle abdominal flaps was performed at our institution. After adequate debridement of gangrenous soft tissue, bone was remained without other tissue coverage. Random pedicle abdominal flap was designed and inset was done immediately. Division of the flap was performed in delayed manner. The patient surgical outcomes were collected and analyzed.

Results
A total of 4 patients underwent staged pedicle abdominal flap reconstruction for hand and digit defects. Surgical indications were degloving injury, frost bite and necrotizing fasciitis of the digits. The mean age at surgery was 42 years old. The abdominal flaps were all designed in a relatively loose area, orientated along minimal skin tension lines. The average time to division was 24.5 days. All flaps survived with no ischemia, wound dehiscence, nor infection. No patients required additional local flaps or free tissue transfer. The reconstructions were successful in 100% of patients.

Conclusion
Using random pedicle abdominal flaps for finger and hand reconstruction is a well-established technique, and it may still be feasible with necrotic bone remaining defects. Although some drawbacks are documented, this method continues to show applicability, feasibility, and reliability, with an optimal aesthetic outcome.