Deep hand burns usually lead to joint and tendon exposure. A simple skin graft is insufficient to achieve healing. Soft tissue reconstruction represents a surgical challenge that ranges from the simplest to the most complex flaps. In some areas, microsurgery is not technically possible. Choice is then limited to pedicled distant flaps such as the abdominal wall flap-graft. We report a case of an acute burned hand with exposure of metacarpophalangeal joints from the second to the fourth radius as well as proximal inter phalangeal joints from the second to the fifth radius and extensor tendons, treated in the burns and wound care unit of the Sylvanus Olympio Teaching Hospital in Lomé. The dorsum hand and fingers were covered with a pedicled abdominal flap-graft that was severed in two stages at 22 and 29 days. We achieved good results (sensitivity S3+, useful aesthetic hand) at two-year follow up.
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