Composite tissue transfer in upper extremity trauma.

SUMMARY: Unlike congenital malformations or defects resulting from tumour ablation, trauma of the upper extremity is more complex to manage. Also because of the structural complexity of the upper extremity, tissue defects often result in exposure of vital structures such as bone, nerve, blood vessels and tendons. Thus, a successful reconstruction after upper extremity trauma must be approached with the goals of not only providing stable coverage but most importantly, restoring function. We present the state-of-the-art material on composite tissue transfer in upper extremity trauma. This chapter describes the modern philosophy of emergency wound management, the optimal timing of reconstruction, and the basic principles in selection of coverage tissue, as well as outlining the advantages, disadvantages, and indications of several most commonly used flaps. In our opinion, radical debridement followed by primary reconstruction is always the first choice when treating traumatic injuries. Microsurgical transplantation of composite tissue to the upper extremity results in the best wound coverage and early functional rehabilitation. Simultaneously, multicomponent reconstruction can also be achieved with minimal donor site morbidity and aesthetically acceptable donor sites.