Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Area of Science:

• Orthopedic Surgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Complete circumferential soft tissue defects of the upper extremity are uncommon and pose significant reconstructive challenges.
• The unique anatomy of the upper extremity necessitates tailored treatment approaches for these defects.
• Understanding the etiology is crucial for effective patient and wound management.

Purpose of the Study:

• To review and summarize the available reconstructive options for complete circumferential soft tissue defects in the upper extremity.
• To provide an overview of current treatment strategies based on a comprehensive literature review.

Main Methods:

• A systematic literature review was conducted using PubMed and MEDLINE databases up to December 2016.
• Included studies focused on forearm and arm defects proximal to the wrist, assessed using Tajima's classification.
• Data analyzed included patient demographics, etiology, defect size, reconstructive techniques, and outcomes.

Main Results:

• Fourteen articles comprising 50 patients were analyzed, with a mean age of 28.1 years.
• Etiologies ranged from severe burns and high-impact trauma (degloving, avulsion, crush) to iatrogenic causes post-tumor removal.
• Reconstructive techniques varied widely, from negative pressure wound therapy to hand transplantation.

Conclusions:

• Reconstructive techniques for upper extremity soft tissue defects have advanced, improving functional and aesthetic rehabilitation.
• A proposed management algorithm can address the complexities of these injuries.
• Tailored treatment is essential for optimal outcomes in these challenging cases.