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Despite the inherent advantages of free flaps for soft tissue cover in upper limb reconstruction, pedicled flaps remain the workhorse in many centers worldwide. Presumed disadvantages of pedicled flaps are that it requires multiple stages, longer hospital stay, are bulky, and primary reconstruction of composite defects cannot be done. Refinements in technique during planning can offset many of the disadvantages. Pedicled flaps are quick and easy to raise and do not need any special microsurgical expertise. Where free flaps are not possible or they fail, pedicled flaps are the lifeboat. An upper limb reconstructive surgeon must be adept at performing these flaps in challenging situations.

A groin flap is an axial-patterned cutaneous flap based on the superficial circumflex iliac arteriovenous system, which can provide soft-tissue coverage to defects on any aspect of the hand and the distal two thirds of the forearm. One of the presumed disadvantages of the pedicled groin flap is the discomfort experienced by the patient during the time required before flap division. These disadvantages can be greatly reduced by proper planning to orient the flap toward the defect, avoid any kinking at the base, and increasing the inset. We present our technique of orienting the flap to fit to the defect to be covered with ease. This technique avoids a lengthy flap and tubing, increases the patients comfort, and also makes the division and inset of the flap easier. As described, we have found this method simple and easy to duplicate.

Nail bed injuries are common and management of these requires good knowledge of the nail bed anatomy. Proper management of these injuries will ensure good healing and prevent late deformities. When loss occurs it is challenging to reconstruct which can be done by grafts or microsurgical reconstruction to restore aesthetic appearance of fingers.

The hand is ranked among the three most frequent sites of burns scar contracture deformity. One of the major determinants of the quality of life in burns survivors is the functionality of the hands. Burns deformities, although largely preventable, nevertheless do occur when appropriate treatment is not provided in the acute situation or when they are part of a major burns. Reconstructive procedures can greatly improve the function of the hands. Appropriate choice of procedures and timing of surgery followed by supervised physiotherapy can be a boon for a burns survivor.

Postburn deformities can cause loss of livelihood and a sense of self-worth. Though many can be corrected leading the patients to lead a productive life, tragically many of these patients who need help are not in the service loop. Causes may be the problems of affordability, reach or the lack of skill levels needed for difficult problems. Hope after fire, a project to offer totally free reconstructive surgery for the correction of burn deformities is a joint initiative of the Rotary Club of Coimbatore Metropolis and Ganga Hospital. In a 3-year period from 2012,304 reconstructive procedures were done in 192 patients with a project value of Rs. 1.08 crores (US $ 166,000). The project is guaranteed the continued support of the club and the community and pledges for a similar sum are available. We feel that this success is reproducible. A patient-centric attitude, the commitment of the people involved in the project to go for it irrespective what it takes to reach the goal, efforts at rehabilitation in addition to surgical efforts, and transparency and trust between partners are the key for success. These and the other factors which we feel are important for success are detailed in this article.