Soft Tissue Reconstruction of the Hand and Arm-Soft Tissue Reconstruction of the Hand and Arm Overview

Soft Tissue Reconstruction of the Hand and Arm Overview

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Soft tissue reconstruction of the hand and arm involves a variety of techniques and options. The reconstructive ladder is a framework for approaching treatment, starting with the simplest solutions and progressing to more complex ones if necessary. Secondary intention, where the wound is allowed to heal on its own, is suitable for small clean defects without exposed bone or significant deep tissue loss. This method allows for early joint mobilization but may result in local tenderness, cold intolerance, and poor cosmetic results.<br /><br />Skin grafts are another option, with split-thickness skin grafts (STSG) and full-thickness skin grafts (FTSG) being the main types. STSG involves harvesting a thin layer of skin from the thigh and meshing it for coverage of larger areas. FTSG involves removing the epidermis and full dermis layer from areas such as the groin or lower abdomen. FTSG offers less wound contracture and faster maturation but has a lower survival rate and a higher risk of infection compared to STSG.<br /><br />There are also various types of flaps that can be used for reconstruction. Random pattern flaps rely on blood supply from small unnamed vessels and include options like bilobed flaps and rhomboid flaps. Axial pattern flaps preserve a single vessel along the long axis of the flap and can be fasciocutaneous, muscle, musculocutaneous, osteocutaneous, or composite.<br /><br />Local flaps are taken from adjacent areas to the wound, such as Z-plasty and Atasoy volar V-Y advancement for fingertip amputations. Regional flaps, like the posterior interosseous artery flap and the radial forearm flap, are used to cover larger defects. Distant flaps, such as the groin flap and latissimus dorsi flap, involve larger areas of tissue transfer.<br /><br />Free tissue transfer involves taking tissue from one part of the body and transferring it to the hand or arm. This requires careful consideration of the donor site, donor type, and recipient vessels. Negative pressure wound therapy and the use of Alloderm and Integra are also mentioned as additional techniques for wound healing and grafting.<br /><br />Overall, soft tissue reconstruction of the hand and arm requires a comprehensive understanding of different techniques and careful consideration of individual patient factors to achieve optimal outcomes.

Keywords

soft tissue reconstruction

hand

arm

reconstructive ladder

secondary intention

skin grafts

split-thickness skin grafts

full-thickness skin grafts

flaps

free tissue transfer