Soft Tissue Coverage of the Upper Extremity

Chim, Harvey; Ng, Zhi Yang; Carlsen, Brian T.; Mohan, Anita T.; Saint‐Cyr, Michel

doi:10.1016/j.hcl.2014.08.002

Cited by 30 publications

(34 citation statements)

References 53 publications

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“…Defects of the upper extremity may involve different tissue types with specific functions (i.e., muscles or tendons involved in hand and finger mobility) and large coverage area that allows secondary procedures, if needed [10] . It would be preferable to avoid flaps that need to sacrifice the radial or ulnar artery, in order not to alter and diminish the vascular inflow and outflow from the already damaged limb, causing not only sensory alteration and cold intolerance but also chronic edema and tissue ischemia [11][12][13] . If the function of flexors or extensors of fingers or other joints (i.e., wrist or elbow) is damaged, a functioning muscle transfer may be used [14,15] .…”

Section: Upper Extremitymentioning

confidence: 99%

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Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Bolletta¹,

Rubino²,

Chen³

2019

PAR

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In the recent decades, microsurgical reconstruction has evolved from simple survival of the affected extremity to the improvement of functional and aesthetic outcome. This review retraces the main contributions to the advances of microsurgery for reconstruction of upper and lower extremities and limb preservation. In the upper extremity, it is important to restore fine motility, together with allowing prompt mobilization. In the lower limb, care must be taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe wearing. Local perforator flaps can be considered for medium size defects. They provide thin coverage and can be performed in short operating time. Their use, though, is often limited by tissue availability. Free flaps allow to overcome this problem and, thanks to the recent development in the study of perforator vessels, the microsurgeon can choose the flap with the most appropriate characteristics. Chimeric flaps can accomplish simultaneous reconstruction of different tissue components and large bone defects often require vascularized bone reconstruction. When dealing with limb preservation it is very important to consider residual functionality. Functioning muscle transfer and targeted muscle re-innervation can be performed in these cases. A useful reconstructive tool in severely damaged limbs with limited blood supply is the use of cross-leg free flaps. In conclusion, extremity reconstruction and limb preservation are reaching new heights thanks, not only to the work of plastic surgeons, but also to the new developments in other fields of study such as oncology, traumatology, radiology and medical engineering.

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Section: Upper Extremitymentioning

confidence: 99%

“…The rectus abdominis muscle flap is a bulky flap suitable for obliterating space in deep, moderate-size wounds. Donor site morbidity is its major concern, with abdominal bulge and hernia formation [11,[64][65][66] . Free muscle flaps are also used for functioning muscle transfer in upper and lower extremity.…”

Section: Muscle Flapsmentioning

confidence: 99%

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Bolletta¹,

Rubino²,

Chen³

2019

PAR

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“…As a last resort, the harvest and use of spare parts from amputated segments can be used for wound closure and restoration of function . These options have been described in the literature at length and are outside the scope this review . In general, the reconstructive ladder (Figure ) should be followed, as the ladder accommodates not only the wound type but also the surgeon's skill level and available resources.…”

Section: Surgical Reconstruction Following Tumor Resectionmentioning

confidence: 99%

“…85,86 These options have been described in the literature at length and are outside the scope this review. 60,[87][88][89][90][91][92][93] In general, the reconstructive ladder ( Figure 1) should be followed, as the ladder accommodates not only the wound type but also the surgeon's skill level and available resources.…”

Section: Soft-tissue Coveragementioning

confidence: 99%

Primary tumors of the hand: Functional and restorative management

Bowen

Landau

Badash

et al. 2018

Journal of Surgical Oncology

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Primary malignant tumors of the hand are rare. Most cases present to clinics unaffiliated with cancer centers, making it incumbent on all hand surgeons to understand the pathology indicative of malignancy and the proper course of treatment of hand neoplasms. In this review, we report, based on tumor type, the anatomical considerations, proper management, staging, surgical approaches, reconstructive considerations, and long‐term surveillance of primary malignant tumors of the hand.

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“…Soft tissue composition also differs significantly depending on the specific area of the upper extremity, with thicker palmar surface of the hand providing protection and precise sensitive feedback versus the thin and supple dorsal counterpart, which affords unimpeded glide to underlying tendons and musculature. In addition, underlying avascular structures of the volar portion make for a poor recipient site to any newly grafted skin, and the limited area of adjacent tissue and relative lack of superfluous musculature make for a paucity of available local or regional flaps, especially in cases of extensive upper extremity injury …”

Section: Introductionmentioning

confidence: 99%

Negative pressure wound therapy as a definitive treatment for upper extremity wound defects: A systematic review

Shine

Efanov

Paek

et al. 2019

International Wound Journal

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Negative pressure wound therapy (NPWT) represents one of the many solutions for complex wounds of the upper extremity. The goal of this study was to investigate the most common indications for definitive treatment of wound defects in the upper extremity with NPWT and to report revision surgery outcomes after its use. A systematic review of the literature was performed. The following keywords and their combinations were used: "upper extremity," "arm," "forearm," "wrist," "hand," "finger" AND "negative-pressure wound therapy," "VAC therapy," "vacuum assisted closure." A total of 45 articles were included, regrouping 404 cases of NPWT in the upper extremity. The forearm was involved in 53% of cases, followed by hand (36%), fingers (10%), and arm (1%). Seventeen different indications were cited, the most common of which were radial forearm flap reconstruction (23%), burn wounds (18%), and compartment syndromes (17%). Of the cases, 90% did not require any subsequent surgical procedure, as opposed to 6% considered partial failures requiring minor revisions and 4% total failures requiring major revisions. Closure of radial forearm flap donor site required the most revision procedures when treated with NPWT. NPWT can be used for several indications pertaining to the reconstruction of the upper extremity. Positive outcomes as a definitive treatment are demonstrated in this systematic review, which reaffirms NPWT as a potent tool for reconstructive endeavours. K E Y W O R D S hand, NPWT, upper extremity, VAC

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Soft Tissue Coverage of the Upper Extremity

Cited by 30 publications

References 53 publications

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Primary tumors of the hand: Functional and restorative management

Negative pressure wound therapy as a definitive treatment for upper extremity wound defects: A systematic review

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