Reconstruction following resection of malignancies of the upper extremity.

A multidisciplinary approach using advances in diagnosis, staging, adjuvant therapy, surgical resection, and especially reconstruction has made limb salvage a viable option in the treatment of most upper extremity malignancies. Although adequate surgical resection never should be compromised by reconstructive considerations, the reconstructive surgeon's input into preoperative planning may be crucial to the best possible functional and aesthetic outcome. Emphasis should be placed on a thorough evaluation by all members of the treatment team so that the best possible result is not compromised. A broad spectrum of techniques currently available for both salvage and restoration of function includes local soft-tissue flaps, regional pedicled and vascular island flaps, free tissue transfers, bone autografts and allografts (Fig. 17), endoprostheses, skin expansion, skeletal lengthening techniques, tendon transfers, and nerve and arterial grafts. This article reviews both new and well-established reconstructive options after resection of upper extremity malignancies in children and adults and provides illustrative case examples.