Interdisciplinary reconstructions of the forearm and hand

TL;DR

This paper explores how combining different surgical techniques improves outcomes for complex forearm and hand injuries.

Contribution

The study highlights the importance of interdisciplinary collaboration and tailored surgical planning in upper extremity reconstruction.

Findings

Free flaps were used for larger defects, while local/regional flaps addressed smaller, zone-specific injuries.

Trauma was the leading cause of defects, followed by oncologic resection and infection.

Interdisciplinary cooperation led to favorable functional and aesthetic outcomes with a low complication rate.

Abstract

This study examines the clinical application of interdisciplinary reconstructive strategies for complex forearm and hand defects. Emphasis is placed on principles guiding flap selection, anatomical localization, and the central role of plastic surgeons within coordinated surgical teams. The aim is to clarify how collaborative planning and technique adaptation influence reconstructive outcomes in upper extremity salvage.

A retrospective review was conducted of 79 patients who underwent upper extremity reconstruction between 2020 and 2024 at a tertiary care center. Inclusion required composite defects of the hand or forearm treated with local, regional, or free flaps. Demographics, etiology, defect location, reconstructive technique, interdisciplinary collaboration, and complications were analyzed descriptively.

Most patients were male (n=62), with a mean age of 53.3 years. Defects most often involved the long fingers (n=32) and thumb (n=31). Trauma (68 %) was the main cause, followed by oncologic resection (22 %) and infection (10 %). Free flaps (n=15) were primarily used for larger or composite defects requiring microsurgical reconstruction, while local and regional flaps were employed zone-specifically for smaller soft tissue defects, especially in digits and thumb. Functional reconstruction addressed tendon, nerve, vessel, and bone injuries. The overall complication rate was 12.6 %, with no flap failures or limb loss.

Upper limb reconstruction benefits from individualized, anatomy-driven planning and interdisciplinary cooperation. Plastic surgeons play a key role in adapting techniques to anatomical zones, achieving favorable functional and aesthetic outcomes.

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