Microsurgical Reconstruction of the Upper Extremity

Preface......Page 5
Range of movement, bone, and tendon......Page 7
Classification......Page 8
Indications for replantation......Page 9
Digit......Page 10
Dorsal repair......Page 11
Distal replants......Page 12
Prolonged ischemia and the ‘‘no reflow’’ phenomenon......Page 13
Survival......Page 14
Function......Page 15
Summary......Page 16
References......Page 17
Initial emergent care......Page 19
Operative techniques......Page 21
Postoperative care......Page 23
Results......Page 25
References......Page 26
Radical versus serial debridement......Page 28
Principles of radical debridement......Page 29
Emergency free flaps......Page 31
History......Page 32
Lateral arm flap......Page 33
Groin flap......Page 35
Immediate reconstruction......Page 36
References......Page 41
Initial requirements......Page 42
Indications for free flaps......Page 43
Selection of free flaps......Page 44
Radial forearm flap......Page 45
Anterolateral thigh flap......Page 46
Osteocutaneous free fibular flap......Page 47
Latissimus dorsi flap......Page 48
Serratus muscle flap......Page 49
Postoperative care......Page 50
References......Page 52
History......Page 54
Specific indications......Page 55
Scapulo-humeral defect......Page 56
Radius/ulna diaphyseal defect......Page 58
Forearm-carpal defect......Page 59
Summary......Page 60
References......Page 61
History of muscle transplantation......Page 62
Indications......Page 63
Functioning free muscle transfer......Page 64
Management of established Volkmann’s ischemic contracture......Page 65
Clinical assessment......Page 66
Functioning free muscle transfer for Volkmann’s ischemic contracture......Page 67
Gracilis muscle preparation......Page 69
Gracilis muscle transfer to the forearm......Page 70
Postoperative care......Page 72
Complications......Page 73
Operative technique of muscle transplantation to the arm for biceps function......Page 74
Results......Page 75
References......Page 77
Anatomic......Page 78
Intraoperative methods of fascicular identification......Page 79
Nerve grafting......Page 80
Nerve transfers......Page 81
Summary......Page 84
References......Page 85
Adult brachial plexus injuries......Page 87
Conventional versus microneurosurgical treatment for complete brachial plexus palsy......Page 88
Restoring shoulder function in incomplete brachial plexus palsy by way of microneurosurgical reconstruction......Page 89
Incomplete brachial plexus palsy in the adult-lower lesion (C8, T1)......Page 90
Babies with complete (global) palsies......Page 91
References......Page 92
Neurotization......Page 94
Extraplexus neurotization......Page 95
Close-target neurotization......Page 98
General principles for neurotization......Page 99
For shoulder function......Page 100
For elbow flexion......Page 101
Functioning free muscle transplantation......Page 102
Gracilis muscle dissection and muscle insertion......Page 103
XI nerve dissection......Page 104
Postoperative management and rehabilitation......Page 105
References......Page 106
History of thumb reconstruction......Page 108
Preoperative evaluation......Page 109
Surgical technique......Page 110
Postoperative management......Page 114
Postoperative monitoring......Page 115
References......Page 117
Initial management of the patient with nonreplantable finger amputation(s)......Page 119
Reconstruction of single finger amputations......Page 120
Reconstruction of multiple finger amputations......Page 121
Reconstruction of metacarpal hands......Page 122
Dissect the toe vascular pedicles in a retrograde fashion......Page 125
Close the donor site primarily and avoid incisions over weight-bearing areas......Page 126
Measures to avoid flexion deformities in transplanted toes......Page 127
References......Page 128
Evolving indications......Page 131
Parental explanation......Page 132
Evaluation of the child......Page 133
Surgical technique......Page 134
Results......Page 136
References......Page 137