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CC BY-NC 4.0 · Arch Plast Surg 2017; 44(02): 117-123
DOI: 10.5999/aps.2017.44.2.117
Original Article

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Zhi Yang Ng
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
,
Shaun Shi Yan Tan
Royal College of Physicians and Surgeons of Glasgow, Scotland, UK
,
Alexandre Gaston Lellouch
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
,
Curtis Lisante Cetrulo Jr
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
,
Harvey Wei Ming Chim
Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Background Upper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity.

Methods A literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available).

Results In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation.

Conclusions With the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.

Keywords

Upper extremity - Reconstructive surgical procedures - Soft tissue injuries


Publication History

Received: 03 September 2016

Accepted: 06 February 2017

Article published online:
20 April 2022

© 2017. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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