Semin Plast Surg 2015; 29(01): 005-009
DOI: 10.1055/s-0035-1544165
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Approach to Complex Upper Extremity Injury: An Algorithm

Zhi Yang Ng
1   Department of Orthopaedic Surgery, Alexandra Hospital, Singapore
,
Morad Askari
2   Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida
,
Harvey Chim
2   Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Publikationsverlauf

Publikationsdatum:
04. Februar 2015 (online)

Abstract

Patients with complex upper extremity injuries represent a unique subset of the trauma population. In addition to extensive soft tissue defects affecting the skin, bone, muscles and tendons, or the neurovasculature in various combinations, there is usually concomitant involvement of other body areas and organ systems with the potential for systemic compromise due to the underlying mechanism of injury and resultant sequelae. In turn, this has a direct impact on the definitive reconstructive plan. Accurate assessment and expedient treatment is thus necessary to achieve optimal surgical outcomes with the primary goal of limb salvage and functional restoration. Nonetheless, the characteristics of these injuries places such patients at an increased risk of complications ranging from limb ischemia, recalcitrant infections, failure of bony union, intractable pain, and most devastatingly, limb amputation. In this article, the authors present an algorithmic approach toward complex injuries of the upper extremity with due consideration for the various reconstructive modalities and timing of definitive wound closure for the best possible clinical outcomes.

 
  • References

  • 1 Levin LS. The reconstructive ladder. An orthoplastic approach. Orthop Clin North Am 1993; 24 (3) 393-409
  • 2 Neumeister MW, Brown RE. Mutilating hand injuries: principles and management. Hand Clin 2003; 19 (1) 1-15 , v v
  • 3 Togawa S, Yamami N, Nakayama H, Mano Y, Ikegami K, Ozeki S. The validity of the mangled extremity severity score in the assessment of upper limb injuries. J Bone Joint Surg Br 2005; 87 (11) 1516-1519
  • 4 Burkhalter W. Mutilating injuries of the hand. Hand Clin 1986; 2 (1) 45-68
  • 5 Spyropoulou A, Jeng SF. Microsurgical coverage reconstruction in upper and lower extremities. Semin Plast Surg 2010; 24 (1) 34-42
  • 6 Scheker LR, Ahmed O. Radical debridement, free flap coverage, and immediate reconstruction of the upper extremity. Hand Clin 2007; 23 (1) 23-36
  • 7 Hassinger SM, Harding G, Wongworawat MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Relat Res 2005; 439 (439) 27-31
  • 8 Bumbasirevic M, Stevanovic M, Lesic A, Atkinson HD. Current management of the mangled upper extremity. Int Orthop 2012; 36 (11) 2189-2195
  • 9 Mackinnon SE, Dellon AL. Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube. Plast Reconstr Surg 1990; 85 (3) 419-424
  • 10 Graham B, Adkins P, Tsai TM, Firrell J, Breidenbach WC. Major replantation versus revision amputation and prosthetic fitting in the upper extremity: a late functional outcomes study. J Hand Surg Am 1998; 23 (5) 783-791
  • 11 Prasarn ML, Helfet DL, Kloen P. Management of the mangled extremity. Strateg Trauma Limb Reconstr 2012; 7 (2) 57-66
  • 12 Brown RE, Wu TY. Use of “spare parts” in mutilated upper extremity injuries. Hand Clin 2003; 19 (1) 73-87 , vi vi
  • 13 Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78 (3) 285-292
  • 14 Lister G, Scheker L. Emergency free flaps to the upper extremity. J Hand Surg Am 1988; 13 (1) 22-28
  • 15 Chen SH, Wei FC, Chen HC, Chuang CC, Noordhoff MS. Emergency free-flap transfer for reconstruction of acute complex extremity wounds. Plast Reconstr Surg 1992; 89 (5) 882-888 , discussion 889–890
  • 16 Hallock GG. The utility of both muscle and fascia flaps in severe upper extremity trauma. J Trauma 2002; 53 (1) 61-65
  • 17 Harrison BL, Lakhiani C, Lee MR, Saint-Cyr M. Timing of traumatic upper extremity free flap reconstruction: a systematic review and progress report. Plast Reconstr Surg 2013; 132 (3) 591-596
  • 18 Sinha K, Chauhan VD, Maheshwari R, Chauhan N, Rajan M, Agrawal A. Vacuum assisted closure therapy versus standard wound therapy for open musculoskeletal injuries. Adv Orthop 2013; 2013: 245940
  • 19 Steiert AE, Gohritz A, Schreiber TC, Krettek C, Vogt PM. Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure (VAC) therapy - worse or worth?. J Plast Reconstr Aesthet Surg 2009; 62 (5) 675-683
  • 20 Roberts CS, Pape HC, Jones AL, Malkani AL, Rodriguez JL, Giannoudis PV. Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma. Instr Course Lect 2005; 54: 447-462
  • 21 Parrett BM, Talbot SG, Pribaz JJ, Lee BT. A review of local and regional flaps for distal leg reconstruction. J Reconstr Microsurg 2009; 25 (7) 445-455
  • 22 Neumeister M, Hegge T, Amalfi A, Sauerbier M. The reconstruction of the mutilated hand. Semin Plast Surg 2010; 24 (1) 77-102
  • 23 Saint-Cyr M, Gupta A. Indications and selection of free flaps for soft tissue coverage of the upper extremity. Hand Clin 2007; 23 (1) 37-48
  • 24 Russell RC, Bueno Jr RA, Wu TY. Secondary procedures following mutilating hand injuries. Hand Clin 2003; 19 (1) 149-163
  • 25 Kuiken TA, Miller LA, Lipschutz RD , et al. Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study. Lancet 2007; 369 (9559) 371-380
  • 26 Petruzzo P, Dubernard JM. The International Registry on Hand and Composite Tissue Allotransplantation. Clin Transpl 2011; 247-253