Microvascular reconstruction of the hand

For the patient with a demonstrated occlusion in either the major arterial supply of the hand or in the distal digital circulation, modern microsurgery offers an opportunity for reconstruction with restoration of normal flow and sensibility. Observation should not be the mainstay of therapy for digital or upper extremity ischemic symptoms. The surgeon may select from a myriad of sophisticated invasive and noninvasive tests that permit definitive identification of microvascular pathology. Until further improvement in pharmacologic treatment occurs, microsurgery offers the greatest opportunity for correction of these conditions.