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Semin Plast Surg 2003; 17(1): 049-068
DOI: 10.1055/s-2003-39856
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Indications for Microvascular Upper Extremity Reconstruction

David T. Netscher
  • Division of Plastic Surgery, Baylor College of Medicine and Department of Plastic Surgery Service, Department of Veterans Affairs, Medical Center, Houston, TX
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Publication History

Publication Date:
16 June 2003 (online)

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ABSTRACT

This article defines the optimum choices for soft tissue and bone defects in upper extremity reconstructions. Under certain circumstances, pedicle flaps may be a better choice than microvascular tissue transfer. Some of the pedicle transfers such as the intrinsic hand flaps and pedicled vascularized bone grafts around the wrist require microvascular tissue handling techniques, although a microvascular anastomosis is not specifically performed. Although refinements in pedicle flaps have defined their role in reconstructive upper extremity surgery, many reconstructions could not be performed without microvascular tissue transfer. Specific indications for microvascular upper extremity reconstruction are discussed.

KEYWORDS

Microvascular upper extremity reconstruction - pedicle transfers - microvascular tissue transfer

REFERENCES

  • 1 Gottlieb L J, Krieger L M. From the reconstructive ladder to the reconstructive elevator (editorial).  Plast Reconstr Surg . 1994;  93 1503
    CrossrefPubMedGoogle Scholar
  • 2 Foucher G, Braun J B. A new island flap transfer from the dorsum of the index to the thumb.  Plast Reconstr Surg . 1979;  63 344-394
    CrossrefPubMedGoogle Scholar
  • 3 Evans D M, Martin D L. Step advancement island flap for fingertip reconstruction.  Br J Plast Surg . 1988;  41 105-111
    PubMedGoogle Scholar
  • 4 Sheetz K K, Bishop A P, Berger R A. The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts.  J Hand Surg . 1995;  20A 902-914
    PubMedGoogle Scholar
  • 5 Zaidemberg C, Siebert J W, Angrigiani C. A new vascularized bone graft for scaphoid nonunion.  J Hand Surg . 1991;  16A 474-478
    PubMedGoogle Scholar
  • 6 Pierer G, Steffen J, Hoflehener H. The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery. An anatomical study in cadavers.  Surg Radiol Anat . 1992;  14 103-112
    CrossrefPubMedGoogle Scholar
  • 7 Bostwick J, Nahai F, Wallace J G, Vasconez L O. Sixty latissimus dorsi flaps.  Plast Reconstr Surg . 1979;  63 31-41
    CrossrefPubMedGoogle Scholar
  • 8 Landra A P. The latissimus dorsi musculocutaneous flap used to resurface a defect on the upper arm and restore extension of the elbow.  Br J Plast Surg . 1979;  32 275-277
    CrossrefPubMedGoogle Scholar
  • 9 Zancolli E, Mitre H. Latissimus dorsi transfer to restore elbow flexion.  J Bone J Surg . 1973;  55A 1265-1275
    PubMedGoogle Scholar
  • 10 Mayou B J, Whitby D, Jones B N. The scapular flap: an anatomical and clinical study.  Br J Plast Surg . 1982;  35 8-13
    CrossrefPubMedGoogle Scholar
  • 11 Lister G D. The theory of the transposition flap and its practical application in the hand.  Clin Plast Surg . 1981;  8 115-128
    PubMedGoogle Scholar
  • 12 Zancolli E A, Angrigiani C. Posterior interosseus island flap.  J Hand Surg . 1988;  13B 130-135
    PubMedGoogle Scholar
  • 13 Soutar D S, Tauner N S. The radial forearm flap and the management of soft tissue injuries of the hand.  Br J Plast Surg . 1984;  37 18-26
    CrossrefPubMedGoogle Scholar
  • 14 Lanzetta M, Mastropasqua B, Chollet A, Brisebois N. Versatility of the homodigital triangular neurovascular island flap in fingertip reconstruction.  J Hand Surg . 1995;  20B 824-829
    PubMedGoogle Scholar
  • 15 Lai C S, Lin S D, Yang C C. The reverse digital artery flap for fingertip reconstruction.  Ann Plast Surg . 1989;  22 495-500
    CrossrefPubMedGoogle Scholar
  • 16 Lai C S, Lin S D, Chou C K, Tsai C W. Innervated reverse digital artery flap through bilateral neurorrhaphy for pulp defects.  Br J Plast Surg . 1993;  46 483-488
    PubMedGoogle Scholar
  • 17 Buncke H J, Rose E H. Free toe-to-fingertip neurovascular flaps.  Plast Reconstr Surg . 1979;  63 607-612
    CrossrefPubMedGoogle Scholar
  • 18 Smith P J, Foley B, MacGregor I A, Jackson I T. The anatomical basis of the groin flap.  Plast Reconstr Surg . 1972;  49 41-47
    CrossrefPubMedGoogle Scholar
  • 19 Gordon L, Bucke H J, Alpert B S. Free latissimus dorsi muscle flap with split-thickness skin graft cover: a report of 16 cases.  Plast Reconstr Surg . 1982;  70 173-178
    PubMedGoogle Scholar
  • 20 Netscher D T, Alford E L, Wigoda P. Free composite myo-osseous flap with serratus anterior and rib: indications in head and neck reconstruction.  Head Neck J . 1998;  20 106-112
    PubMedGoogle Scholar
  • 21 Katsaros J, Tan E, Zoltie N. The use of the lateral arm flap and upper limb surgery.  J Hand Surg . 1991;  16A 598-604
    PubMedGoogle Scholar
  • 22 Upton J, Rogers C, Durham-Smith G, Schwartz S W, Swartz W M. Clinical applications of free temporoparietal flaps in hand reconstruction.  J Hand Surg . 1986;  11 475-483
    CrossrefPubMedGoogle Scholar
  • 23 Buncke H J, Valauri F A, Buncke G M. Toe to hand surgery. In: Brunelli G, ed. Textbook of Microsurgery Milan, Italy: Masson 1988: 305-318
    Google Scholar
  • 24 O'Brien B M, MacLeod A M, Sykes P J, Donahoe S. Hallux-to-hand transfer.  Hand . 1975;  7 128-133
    PubMedGoogle Scholar
  • 25 Morrison W A, O'Brien B M, MacLeod A M. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe.  J Hand Surg . 1980;  5A 575-583
    PubMedGoogle Scholar
  • 26 Tsai T M, Jupiter J B, Wolff T W, Attasoy E. Reconstruction of severe transmetacarpal mutilating hand injuries by combined second and third toe transfer.  J Hand Surg . 1981;  6A 319-328
    PubMedGoogle Scholar
  • 27 Tsai T M, Wang W Z. Vascularized joint transfers: indications and results (review).  Hand Clin . 1992;  8 525-536
    PubMedGoogle Scholar
  • 28 Manktelow R T, McKee N H. Free muscle transplantation to provide active finger flexion.  J Hand Surg . 1978;  3A 416-426
    PubMedGoogle Scholar
  • 29 Weiland A J, Moore J R, Daniel R K. Vascularized bone autografts: experience with 41 cases.  Clin Orthop . 1983;  174 87-95
    PubMedGoogle Scholar
  • 30 Gao Y H, Ketch L L, Eladoumikdachi F, Netscher D T. Upper limb salvage with microvascular bone transfer for major long-bone segmental tumor resections.  Ann Plast Surg . 2001;  47 240-246
    PubMedGoogle Scholar
  • 31 Taylor G I, Wilson K R, Rees M D. et al . The anterior tibial vessels and their role in epiphyseal and diaphyseal transfer of the fibula: experimental study and clinical applications.  Br J Plast Surg . 1988;  41 451-461
    CrossrefPubMedGoogle Scholar
  • 32 Tomita Y, Tsai T M, Steyers C, Ogden L, Jupiter J B, Kutz J E. The role of the epiphyseal and metaphyseal circulations on longitudinal growth in the dog. An experimental study.  J Hand Surg . 1986;  11A 375-382
    PubMedGoogle Scholar
  • 33 Tsai T M, Ludwig L, Tonkin M. Vascularized fibula epiphyseal transfer: a clinical study.  Clin Orthop . 1986;  210 228-234
    PubMedGoogle Scholar
  • 34 Pho R WH, Patterson M H, Kour A K, Kumar V P. Free vascularized epiphyseal transplantation in upper extremity reconstruction.  J Hand Surg . 1988;  13B 440-447
    PubMedGoogle Scholar
  • 35 Koman L A, Smith B P, Smith T L. Stress testing in the evaluation of upper extremity perfusion (review).  Hand Clin . 1993;  9 59-83
    PubMedGoogle Scholar
  • 36 Jones N F, Raynor S C, Medsger T A. Microsurgical revascularization of the hand in scleroderma.  Br J Plast Surg . 1987;  40 264-269
    CrossrefPubMedGoogle Scholar
  • 37 Flatt A E. Digital artery sympathectomy.  J Hand Surg . 1980;  5A 550-556
    PubMedGoogle Scholar
  • 38 Wilgis E FS. Digital sympathectomy for vascular insufficiency.  Hand Clin . 1985;  1 361-367
    PubMedGoogle Scholar
  • 39 Pederson W C. Revascularization of the chronically ischemic hand.  Hand Clin . 1999;  15 629-642
    PubMedGoogle Scholar
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