G. Karthikeyan1, N. Mariappan2
ABSTRACT: INTRODUCTION: There are situations where the skin is lost along with soft tissues on many fingers at the same time. They may or may not be associated with fractures. The reconstruction of such defects is important to regain both form and function. Traditionally, such multiple defects are reconstructed by converting the multiple defects into a single defect by creating a surgical syndactyly and then planning a skin cover for that defect. This method of reconstruction, though appeared simpler, has the disadvantage in that multiple stages are added to the reconstruction process. Hence subsequent procedures like syndactyly release, flap thinning, underlying tendon reconstruction are delayed, ultimately delaying the patient’s return to useful work. It not only involves more time, but also results in more scar formation during the intervening period, resulting in more effort required at physiotherapy. The other method of reconstruction is by using multiple flaps at the same time for the coverage of the defects. This may be achieved by the louvre abdominal flaps or the step ladder abdominal flaps. Barring a few reports of isolated cases for whom step ladder abdominal flaps have been used,(1)(2) there are no papers in literature reviewing these flaps for hand reconstruction.