Neurosensory free flaps can provide sensibility, vascularity, and soft tissue coverage to an injured hand. In determining the most suitable means of reconstructing a defect, the benefit of the reconstruction has to outweigh the risk of donor morbidity. Appropriate selection of a neurosensory flap is based primarily on the need for tactile discrimination or protective sensation. Because of its thin, glabrous skin, constant vascular and neural anatomy, minima donor morbidity, and in situ 2-point discrimination, the first web space flap of the foot (or its variants) is considered to be the best choice for restoration of critical sensibility to the digital tips or first web space of the hand. Several other neurosensory flaps have been described that can be used to restore protective sensation for other areas on the hand. The return of sensation with these other flap options is variable, and it is crucial to scrutinize the individual reports on the use of these flaps to determine appropriately the chance for long-term sensory ability in selecting a donor neurosensory flap.
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