Microsurgical Reconstruction Of The Upper Extremity

MICROSURGICAL RECONSTRUCTION OF THE UPPER EXTREMITY: STATE OF THE ART CONTENTS Preface Neil F. Jones ix Digital Replantation Wayne A. Morrison and David McCombe 1 The final judgment of whether to replant may not be determined until after microscopic inspection of vessels and nerves is complete. Once committed, it is ultimately the attention to detail that will determine function; bone shortening and rigid fixation, multiple strand flexor tendon repair, and quality, meticulous repair of the extensor mechanism to permit early movement, periosteal approximation to aid gliding, radical debridement of damaged vessels and primary skin closure. Wrist Level and Proximal–Upper Extremity Replantation Douglas P. Hanel and Simon H. Chin 13 Since Malt and McKhan’s first successful arm replantation in 1962, upper extremity replantation surgery techniques have been refined and spread worldwide. Nevertheless, replantation at or proximal to the wrist, referred to as wrist-proximal replants, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation. Radical Debridement, Free Flap Coverage, and Immediate Reconstruction of the Upper Extremity Luis R. Scheker and Omar Ahmed 23 Radical debridement allows the surgeon to prevent infection by skillful use of the scalpel. It is also the necessary foundation for the microsurgical techniques of applying emergency free flaps and performing immediate reconstruction. These techniques ultimately result in fewer days spent in the hospital for patients, a more rapid return to work and other activities, higher levels of functional recovery, and lower costs in the long term for the health care system. Indications and Selection of Free Flaps for Soft Tissue Coverage of the Upper Extremity Michel Saint-C