Free Vascularized Tissue Transfer to Preserve Upper Extremity Amputation Levels

Author(s): Baccarani A, Follmar KE, De Santis G, Adani R, Pinelli M, Innocenti M, Baumeister S, von Gregory H, Germann G, Erdmann D, Levin LS

Source: Plast Recon. Surg 120: 971-81, 2007.

Summary:

 The authors retrospectively investigated the role of free tissue transfer in 13 patients with amputated upper extremities to preserve both morphology and function, with the ultimate goal of facilitating prosthetic rehabilitation.  The cause of amputation was trauma in 92 percent of patients and the mean age was 32 years. In one third of the cases, an emergency “spare parts” free fillet flap was used, and in the remaining two-thirds, a traditional free flap was performed. Complications (such as partial flap loss, vascular impairment, and delayed osseous union) occurred in 38 percent of the cases.  However, the final goal of the procedure for functional outcome and prosthetic rehabilitation was achieved in all cases. The authors conclude that in well-selected cases, free vascularized tissue transfer is of benefit for the preservation of upper extremity amputation level and can facilitate prosthetic rehabilitation and residual limb function.

In instances such as trauma or oncologic resections where upper extremity amputation is necessary, every effort should be made to provide the patient with the most functional residual limb. This usually requires preservation of skeletal length and salvage of critical joints.   To this end, “spare part” free vascularized tissue transfer or traditional free flaps have utility. However, they remain relatively uncommonly performed procedures possibly because of the requirement for microsurgical expertise, concerns about donor site morbidity, and controversial true indications.  There are no previous sizable series reported in the literature.  In this study, the authors report good functional and prosthetic rehabilitation outcomes; and propose a useful treatment algorithm for the management of the amputated upper extremity.

 

Free, Tissue, Transfer, Vascularized, Fibula, Amputation


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