Compound Tissue Transfer in Avascular Upper Limbs

The treatment options for compound defects have significantly changed during the last ten years. Older strategies have frequently included only primary soft tissue coverage and revascularization, and secondary reconstruction of functional structures. Several operative steps were required to achieve functional and∕or aesthetic results, that facilitated the social and professional reintegration of patients. The development of new composite (chimeric) flaps containing various tissue components, based on a single pedicle, has begun a new direction in reconstructive microsurgery. These flaps can be harvested from several donor sites, predominantly the subscapular system, but also the lower leg, the upper arm, or the circumflex femoral system. They can also include arterial or venous segments for vascular interposition grafts.

Exact preoperative planning allows one-stage reconstruction, abbreviation of treatment duration, decrease of treatment costs and time off work, and acceleration of professional reintegration of the patients. This presentation demonstrated algorithms of decision making, and elective examples of combined tissue transfer for compound defects.