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Free vascularized tissue transfer to preserve upper extremity amputation levels
Alessio Baccarani1, Keith E Follmar, Giorgio De Santis
1Durham, N.C.; Modena and Florence, Italy; and Heidelberg, Germany From the Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Duke University Medical Center; Division of Plastic and Reconstructive Surgery, University of Modena and Reggio Emilia; Division of Reconstructive Microsurgery, Careggi University Hospital; and Department of Plastic, Reconstructive, and Hand Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg.
Free vascularized tissue transfer can preserve upper extremity amputation level, aiding prosthetic rehabilitation and limb function. This uncommon procedure is effective in well-selected trauma cases.
Area of Science:
- Microsurgery
- Plastic Surgery
- Reconstructive Surgery
Background:
- Free vascularized tissue transfer is an uncommon procedure for preserving upper extremity amputation levels.
- This study investigates its role in maintaining morphology and function for prosthetic rehabilitation.
Observation:
- A retrospective review of 13 patients undergoing microsurgical free tissue transfer for upper extremity amputation level preservation.
- Data collected included patient demographics, cause of defect, reconstructive procedure, and functional outcomes.
- Trauma was the cause of amputation in 92% of patients, with a mean age of 32 years.
Findings:
- Both emergency free fillet flaps (31%) and traditional free flaps (69%) were utilized.
- Key structures/functions preserved included hand pinch, elbow/shoulder joint function, and skeletal length >7 cm.
- Despite a 38% complication rate, the procedure's goal was achieved in all cases.
Implications:
- Free vascularized tissue transfer is a viable option for well-selected upper extremity amputation cases.
- The procedure facilitates prosthetic rehabilitation and enhances residual limb function.
- A treatment algorithm for managing amputated upper extremities is presented.
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