Abstract
With the advent of the Industrial Revolution, traumatic injuries of the upper extremity
increased exponentially. As a result, surgeons began to reevaluate amputation as the
standard of care. Following the Second World War, local and regional pedicled flaps
became common forms of traumatic upper extremity reconstruction. Today, microsurgery
offers an alternative when options lower on the reconstructive ladder have been exhausted
or will not produce a desirable result. In this article, the authors review the use
of free tissue transfer for upper extremity reconstruction. Flaps are categorized
as fasciocutaneous, muscle, and functional tissue transfers. The thin pliable nature
of fasciocutaneous flaps makes them ideal for aesthetically sensitive areas, such
as the hand. The radial forearm, lateral arm, scapula, parascapular, anterolateral
thigh, and temporoparietal fascia flaps are highlighted in this article. Muscle flaps
are utilized for their bulk and size; the latissimus dorsi flap serves as a “workhorse”
free muscle flap for upper extremity reconstruction. Other muscle flaps include the
rectus abdominis and serratus anterior. Lastly, functional tissue transfers are used
to restore active range of motion or bony integrity to the upper extremity. The innervated
gracilis can be utilized in the forearm to restore finger flexion or extension. Transfer
of vascularized bone such as the fibula may be used to correct large defects of the
radius or ulna. Finally, replacement of “like with like” is embodied in toe-to-thumb
transfers for reconstruction of digital amputations.
Keywords
upper extremity reconstruction - free flap - fasciocutaneous flap - muscle flap -
functional tissue transfer
