Microvascular Reconstruction of the Upper Extremity

Abstract

Where possible, the best results may be achieved by reattaching the amputated original tissues (microsurgical replantation). In noninfected, uncontaminated traumatic injuries resulting in composite soft tissue defects, Early free flap reconstruction of the upper extremities has important advantages over delayed (72 h-3 months) or late wound closure (3 months-2 years). In recent years, thin, pliable, and versatile fasciocutaneous flaps such as the anterolateral thigh (ALT) and lateral arm (LA) free flaps have been increasingly used with great success to reconstruct the upper extremity. The use of "spare parts" and functional reconstructions using osteomyocutaneous free flaps or toe to thumb transfers complete the armamentarium of the upper limb reconstructive microsurgeon.

Single stage soft tissue and extensor tendon reconstruction of upper extremity with antero-lateral thigh free flap- A case report

“…She requires further hand therapy and revision surgery later. Discussion Free flap is the preferred option in reconstruction of complex traumatic soft tissue loss in upper extremity [3,4]. It can cover defects of any size or wound bed conditions, mobility, and offers single stage surgery for soft tissue coverage with multicomponent reconstruction in a shortest duration to facilitate postoperative hand rehabilitation and preserve hand function [4].…”

“…Discussion Free flap is the preferred option in reconstruction of complex traumatic soft tissue loss in upper extremity [3,4]. It can cover defects of any size or wound bed conditions, mobility, and offers single stage surgery for soft tissue coverage with multicomponent reconstruction in a shortest duration to facilitate postoperative hand rehabilitation and preserve hand function [4]. In the case presented, there was a need to replace extensive soft tissue loss on the dorsum of the hand to cover the expose fracture site and wrist joint, extensor tendon reconstruction and sequential radial artery repair to avoid single vessel limb once it is used as a recipient vessel for free flap.…”

“…Primary reconstruction with flap is favoured in complex traumatic injury of the upper extremity as most structures such as tendons, nerves and vessels are easier to locate and repair without the need to operate with difficulty through a scarred tissue [3]. In addition, delayed procedures will further delay the patient's rehabilitation and recovery [3,4]. Exposure of vitals structures such as joint, tendons, vessels, fracture site and/ or hardware demand immediate soft tissue coverage with functional reconstruction of all structures in one setting.…”

Use of the omental free flap for reconstruction of degloving hand and foot injuries: two case reports

“…The degloved tissue defects have an unfavorable bed for skin grafts, so if a split-thickness skin graft is transferred on exposed skeletal structures, necrosis of the graft is very likely to develop [1]. That is why a thin, very pliable, large and well vascularized free flap is the best choice for the reconstruction of degloving hand or foot injuries [1][2][3]. The problem is that it is hard to find all these features in a single flap.…”

“…The problem is that it is hard to find all these features in a single flap. Nowadays degloving injuries are covered with fasciocutaneous [2][3][4][5], perforator-based cutaneous [1,3,6] or musculocutaneous [2,3,7] free flaps. All of the methods mentioned above have disadvantages and are not ideal choices for reconstruction of extensive hand or foot injuries.…”