Indirect Upper Extremity Revascularization With the Latissimus Dorsi Pedicle Flap After Traumatic Amputation

Role of Temporary Arterial Shunt in the Reimplantation of a Traumatic Above-Elbow Amputation

Although the feasibility of reimplantation has increased greatly with the development of new surgical techniques, long-term functional prognosis is unpredictable. Injury to a major nerve is an important factor in long-term outcome, and prolonged ischemia time also has a negative effect. We present a 26-year-old woman whose right arm was sectioned above the elbow in an accident. The limb presented a complete section, with soft tissue loss of the humeral artery and vein, basilic vein, and cephalic vein. Median and radial nerve tissue was missing, and a supracondylar fracture with substantial loss of the humerus was also observed. During reimplantation surgery, a temporary arterial shunt reduced ischemia time. A venous and arterial bypass was performed, and the 12-month results were good.

Rational flap selection and timing for coverage of complex upper extremity trauma

Reconstruction of complex extremity trauma continues to be a challenging task for plastic surgeons. Characteristics of such injuries include destruction of functional structures, often due to high energy trauma that causes significant invalidity. Before the era of free flaps, pedicled fasciocutaneous and muscle flaps were the only option for reconstruction of the severely injured upper extremity. The management of complex injuries of the upper extremity has changed with the development of reconstructive microsurgery. Nowadays, we have a great variety of different free flaps to cover defects of the upper extremity and restore function by innervated free flaps. Sensibility, skin thickness, texture, colour, durability, binding of the flap to the underlying structures, donor site morbidity, possibility of secondary reconstructive procedures, the surgeon's experience and operative facilities must all be taken into consideration for choosing the optimal reconstructive procedure. Not only the reconstructive und functional requirements but the timing of reconstruction is extremely important for final result. The purpose of this paper is to define the principles of flap selection and timing of flap reconstruction, according to the assessment of trauma in the upper limb.