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Microvascular Reconstruction of the Upper Extremity
Iain Whitaker1,2, Ian C Josty2, Vera C van-Aalst1
1Plastic Surgery Research Laboratory, University of Louisville, Louisville, KY, USA.
Summary
Microsurgery offers advanced options for upper extremity reconstruction, prioritizing replantation and early free flap use for optimal functional and aesthetic outcomes in complex tissue defects.
Area of Science:
- Microsurgery and reconstructive surgery
- Plastic and reconstructive surgery
- Trauma surgery
Background:
- Composite tissue defects in the upper extremity stem from trauma, tumors, infections, or congenital issues.
- Reconstruction aims to protect vital structures and achieve optimal function and aesthetics.
- Microsurgery has expanded treatment options, including replantation and free tissue transfer.
Purpose of the Study:
- To describe primary microsurgical techniques for upper extremity tissue defect reconstruction.
- To discuss criteria for selecting appropriate reconstructive techniques.
Main Methods:
- Comprehensive literature review (PubMed, Embase, textbooks).
- Inclusion of personal experiences in upper extremity reconstruction and microsurgery.
Main Results:
- Microsurgical techniques are detailed for reconstructing upper extremity tissue defects.
- Factors influencing technique selection are discussed.
Conclusions:
- Microsurgical replantation is preferred when feasible.
- Early free flap reconstruction offers advantages over delayed closure for traumatic defects.
- Anterolateral thigh (ALT) and lateral arm (LA) free flaps are effective for upper extremity reconstruction.
- Osteomyocutaneous free flaps and toe-to-thumb transfers are valuable reconstructive tools.
