Split-Thickness Skin Graft Reconstruction Following Post-Traumatic Hand Infection: Case Report and Literature Review

Abstract

Background: Hand trauma resulting from occupational machinery accidents represents complex high-energy injuries frequently associated with contamination, tissue necrosis, and soft-tissue infection, which can hinder early cutaneous coverage and compromise functional outcomes. Appropriate management requires effective control of the septic focus, adequate preparation of the recipient bed, and timely reconstruction using reliable coverage techniques.

Case Report: We report the case of a 34-year-old left-hand–dominant male who sustained a traumatic avulsion injury to the left hand during occupational activity. Initial management consisted of primary wound closure; however, the patient subsequently developed a soft-tissue infection with formation of a dorsal abscess, which required surgical drainage and broad-spectrum antibiotic therapy adjusted according to clinical progression. Following serial surgical debridements, a dorsal cutaneous defect measuring 14 × 7 cm with viable granulation tissue was obtained. Definitive coverage was achieved using a split-thickness skin graft (0.30 mm) harvested with an electric dermatome. At five days postoperatively, adequate graft integration was documented, with no evidence of necrosis or persistent infection, allowing the initiation of early functional rehabilitation.

Discussion: Post-traumatic infections of the hand require prompt surgical drainage and targeted antibiotic therapy, as pharmacologic treatment alone is insufficient in the presence of purulent collections. Adequate preparation of the recipient bed represents the most important determinant of successful graft take. In extensive dorsal defects, split-thickness skin grafts offer higher rates of integration due to their lower metabolic demand and greater tolerance to irregularities of the wound bed. Graft incorporation occurs through the sequential phases of plasmatic imbibition, inosculation, and maturation. Early clinical evaluation is therefore essential to identify potential complications and prevent functional impairment.

Conclusion: Sequential control of infection followed by coverage with a split-thickness skin graft represents an effective and safe strategy for the management of extensive dorsal hand defects resulting from occupational trauma. This approach provides stable cutaneous coverage and facilitates early functional rehabilitation.