Revascularization of the chronically ischemic hand.

Chronic ischemia of the upper extremity can pose challenging problems for the reconstructive hand surgeon. With a combined macro- and microvascular approach, many patients can be offered limb salvage rather than amputation. Direct revascularization probably offers the best approach when it can be attempted. The indirect approaches do offer improvement in most patients and are fairly straightforward. Arterialization of the venous system and free omental transfer should be used with caution by surgeons with little experience in microsurgery, however.