Versatility of Free Cutaneous Flaps for Upper Extremity Soft Tissue Reconstruction

Wang, Howard D.; Alonso-Escalante, Jose C.; Cho, Samuel K.; DeJesus, Ramon A.

doi:10.1055/s-0037-1603918

Cited by 21 publications

(18 citation statements)

References 59 publications

(64 reference statements)

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“…Howard et al reviewed survival rates of anterolateral thigh flaps for upper extremity trauma reconstruction and found encouraging rates ranging from 90 to 100% [3]. Nevertheless, the timing of tissue transfer has been hotly debated for years.…”

Section: Introductionmentioning

confidence: 99%

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Kang

Pan

et al. 2020

J Orthop Surg Res

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Background: Despite advances in microsurgical techniques of flap transfer, complex upper extremity trauma reconstruction remains a challenge for surgeons. This study aimed to present the outcomes in using flaps in the subacute reconstruction of complex upper extremity injuries. Methods: From July 2013 to December 2016, 35 patients ranging in age from 23 to 69 years with complicated upper extremity traumatic injuries were treated using flap reconstruction in subacute period. The number and causes of injury were 12 machine crush injuries, 18 machine strangulation injuries, two chainsaw accidents, two traffic accidents, and one incident of heavy bruising. Thirty-five patients underwent flap procedures, including 24 anterolateral thigh flaps (68.57%), five latissimus dorsi flaps (14.29%), and six lateral arm flaps (17.14%). Flap sizes ranged from 3 × 4 to 42 × 16 cm 2. The mean time of flap reconstruction was 14 days (range 5-29). During postoperative follow-up, flap appearance, sensory recovery, scarring and satisfaction were assessed. Results: The overall flap survival rate was 94.3%.Two flaps developed partial necrosis, both of which were later treated with skin grafting. Traumatic wound infections occurred in three patients. All upper limb injuries were completely covered. The follow-up periods ranged from 18 to 62 months with an average of 2.9 months. All skin flap textures were soft with varying degrees of pigmentation. Flap sensory recovery was S 1 in three cases, S 2 in eight cases, S 3 in 15 cases, and S 4 in nine cases. There were no donor site complications other than three cases with scar hyperplasia. Conclusions: The severe upper limb soft tissue defects still achieved satisfactory function and appearance with negligible complications and low amputation rates during the subacute period.

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Section: Introductionmentioning

confidence: 99%

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Kang

Pan

et al. 2020

J Orthop Surg Res

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“…It is a well-known fact that free flaps can provide large and reliable soft tissue cover along with the functioning muscle, bone, nerve, and bridge to the segmental defects of the vessels. [7][8][9] These properties make them first line of choice for a better functional outcome. In the current era of microsurgery, pedicled 10 This has been documented by the experience of several authors with abdominal and groin flaps.…”

Section: Discussionmentioning

confidence: 99%

Thoracoumbilical Flap: Anatomy, Technique, and Clinical Applications in Upper Limb Reconstruction in the Era of Microvascular Surgery

Naalla

Dawar

et al. 2018

J Hand Microsurg

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“…A long pedicle is always an advantage because it allows safer microanastomosis, further away from the wounded area [49,50] . In upper extremity reconstruction, it is advisable to perform end-to-side anastomosis in order to spare main vascular axis and avoid reducing hand perfusion [51] . Muscular, fasciocutaneous and cutaneous flaps can all be used in extremity reconstruction.…”

Section: Free Flapsmentioning

confidence: 99%

“…This affects the aesthetic appearance of the reconstruction. Moreover, muscle flaps may limit tendon gliding and their elevation for secondary surgeries (i.e., tenolysis) is harder [51] . Most commonly used muscle flaps are, according to many authors, latissimus dorsi, serratus anterior, rectus abdominis and gracilis [56][57][58] .…”

Section: Muscle Flapsmentioning

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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Versatility of Free Cutaneous Flaps for Upper Extremity Soft Tissue Reconstruction

Cited by 21 publications

References 59 publications

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Thoracoumbilical Flap: Anatomy, Technique, and Clinical Applications in Upper Limb Reconstruction in the Era of Microvascular Surgery

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

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