Objective: To justify the use of delayed reconstructive interventions in severe complex hand injuries. Methods: The results of delayed reconstructive surgery in 22 patients with a severe complex hand injury for the period from 2010 to 2022 were analyzed. Most of the patients (81.8%) were admitted within 4 to 7 days after injury and received primary care in non-specialized institutions. The age of patients ranged from 17 to 45 years, with the mean age being 28.3 years. They had crush hand injuries with an incomplete avulsion of all fingers (3), II-V fingers (6), II-IV fingers (9), and II-III fingers (1), in three cases, an extensive wound defect of the hand was accompanied by complete amputation of II-III (1) and II-IV fingers (2). The concomitant defect of integumentary tissues had an extended character in case of damage by electric machines (101.2±3.6 cm2) and gunshot wounds (92.1±3.7 cm2). Results: The rationale for the use of delaying tactics was the severity of the injury, the time point of admission, and the decompensation of blood circulation in the fingers in 8 out of 16 admitted patients. All the patients underwent delayed necrosectomy with preservation of the maximum length of viable bone fragments. An extensive defect of the integumentary tissues was covered with a skin-fascial inguinal flap. The second stage performed was one-step directed nerve implantation with phalangization of the transplanted flap (6). For reinnervation, the superficial branch of the radial nerve was most often used as a donor’s nerve. The restoration of sensitivity was registered 3 months after the surgery. Conclusion: As a result of multi-stage complex reconstructive plastic surgery performed on a primary-delayed basis for severe complex hand and fingers injuries, followed by correcting operations to improve the sensory input of the residual segments; the adequate functional outcome was obtained with an improvement in the patient’s quality of life. Keywords: Severe hand injury, hand defects, hand reconstruction, flaps, neurotization.

Objective: To improve the outcomes of surgical correction of upper limb dysfunction (ULD) using the latissimus dorsi flap (LDF). Methods: ULD occurred in 76 patients with Volkmann's ischemic contracture (VIC), post-traumatic soft tissue defects, and brachial plexitis in 57, 11, and 8 cases, respectively. Out of 57 patients with VIC, in 30 cases, a skin defect was observed along with severe degenerative changes in soft tissues, neurovascular bundles (NVBs) and tendons. Post-traumatic forearm defects (n=11) in 5 cases were accompanied by damage to the NVBs and tendons. In brachial plexitis, isolated injury to the musculocutaneous nerve occurred in 6 patients, and a combination of nerve lesions with radial nerve palsy – in 2 patients. Results: Transposition of LDF to the biceps brachii for the treatment of brachial plexitis, free muscle transplantation for the treatment of VIC and forearm soft tissue defects were performed in 8, 57, and 11 cases, respectively. Active forearm flexion after the muscle flap transposition was noted after 4 weeks. In contrast, after graft transplantation in VIC, the grip function restoration began after 6 months and improved within 1 year and beyond. Conclusion: Using the LDF in surgical correction of post-traumatic ULD allowed restoring the lost functions of the crushing grip and forearm flexion. For the forearm, only free flap transplantation with a relatively long period of limb function recovery is possible. In contrast, the traspositioned LDF to the biceps allows achieving the desired functional outcomes in the shortest possible time. Keywords: Upper limb, latissimus dorsi flap, Volkmann's contracture, soft-tissue defect, brachial plexitis.