Upper Extremity Microsurgery

Abstract

After studying this article, the participant should be able to: 1. Understand the indications for free flap coverage of the upper extremity. 2. Know the advantages and disadvantages of the flaps discussed. 3. Have a basic understanding of the anatomy of the flaps discussed. 4. Have a variety of options for free tissue transfer.The application of microsurgical tissue transfer to reconstruction of the upper extremity allows repair of significant bone and soft-tissue defects. Through the years the approach has changed from one of simply getting the wound covered to primary reconstruction to preserve or regain function. A wide variety of free flaps offers the potential to reconstruct nearly any defect of the arm and hand. Vascularized bone transfer can be utilized to repair large bony defects, while innervated free muscle transfer can replace missing muscle function. The total array of flaps and their indications is beyond the scope of a single discussion, but this article focuses on a few flaps that have found application for coverage and functional restoration in the hand and upper extremity.

Anatomical comparison among the anterolateral thigh, the parascapular, and the lateral arm flaps

“…The thinness of the lateral arm flap is an anatomical feature that facilitates its use in a number of surgical procedures. For some authors, it is the best option for intraoral and pharyngeal reconstructions, and for distal extremities reconstructions, like hands and feet …”

Replantation of the upper extremity: Indications and outcomes

“…Dr. Pederson has suggested this option, and it is a good option for adding supple skin over the volar finger. 42 This technique is rarely used, but can be an elegant option for a difficult problem.…”

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

“…Due to their capacity of improving blood supply, their use have also been indicated when dealing with wounds with high infection risk [53,54] . Even in the upper extremity they have been used for large defects, in particular in the proximal arm, where they are still bulky at the beginning, but, thanks to progressive atrophy and revisions it is possible to obtain acceptable results [10,55] . However, muscle flaps have downsides such as sacrificing a functioning muscle and requiring coverage, often with skin grafts.…”