Three-Dimesional Dynamic Skin Movement of Hand Dorsum

Purpose: Hand dorsum is one of the most dynamic region in human body with thin and mobile skin. Faulty reconstruction in this region can cause contracture and functional loss. For a dynamic reconstruction, normal motion and associated skin movement as well as the skin elastic properties should be considered. The authors evaluated the hand dorsum skin dynamics in between the full grip and full extension position for proper dynamic reconstruction.

Methods: Left hand was put in functional position and marked with 5-by-7 grid on the dorsum. While making a full grip and full extension without wrist motion, hand dorsum was scanned with portable 3D scanner. The scanned data was processed to align their three-dimensional axis and the surface markers. The markers’ displacement during hand motion and their dimensional changes were evaluated in three-dimensional coordinate.

Results: Full grip caused dorsal skin dimensional change from 92.2 to 107.12% of its original length in horizontal axis and from 100.80 to 118.75% of the original length in longitudinal axis when compared to full extension position. Dimensional change was variable at every location in the dorsal skin. Radial to second metacarpal area, and each metacarpal base were found to be the least mobile regions during hand motions and act as the dorsal skin axes.

Conclusion: The result shows that hand dorsum is not a uniformly stretchable unit and its reconstruction should be customized according to injury location within the hand dorsum. For the proper dynamic reconstruction of the hand dorsum, consideration of 10-20% of skin stretching is required and Lazy S or Z-plasty incisions are recommended in dorsal ulnar axis.