An algorithm for the reconstruction of nonfingertip upper extremity soft tissue defects

Abstract

Aims: The aim of this study was to evaluate the advantages and disadvantages of reconstructive methods used in the upper extremity soft tissue defects other than the fingertips, according to location. Materials and Methods: This retrospective study included 212 patients operated between January 2012 and January 2019 due to upper extremity soft tissue defects excluding the fingertip. Patients were evaluated in terms of age, gender, etiology, reconstruction area, method, and complications. Statistical Analysis Used: The relationship between the reconstructive method or location and the complication was evaluated by one-way analysis of variance test. The relationship between categorical variables was tested by Kruskal–Wallis test. The significance of multiple comparisons was adjusted using Bonferroni correction. Results: The average age of patients was 35.4 ± 19.12 years; 168 were male and 44 were female. 158 patients were operated for trauma, 34 for malignant tumor, 12 for infection, and 8 for extravasation. Complications were observed in 19 of the 220 reconstructive procedures (8.6%): two of the local flaps, three distant flaps, two regional flaps, five perforator flaps, and seven free flaps. 26% of these complications were seen in fingers, 15% in hands, 42% in wrists, 5.2% in forearms, 5.2% in elbows, and 5.5% in arms. Conclusions: There are many procedures for upper extremity reconstruction that can be selected according to defect location and character. It should be kept in mind that complex reconstructions that are preferred especially in complicated injuries may end up with challenging complications. In these types of complicated injuries, it would be better to prefer a reconstructive ladder instead of a reconstructive elevator.

Keywords

• distant flap
• free flap
• perforator flap
• upper limb
• venous flap