Outcome assessment after reconstruction of complex defects of the forearm and hand with osteocutaneous free flaps.
BACKGROUND
Complex defects of the forearm and hand often require microvascular reconstruction with osteocutaneous free flaps for limb salvage.


METHODS
Fifteen patients with osseous and soft-tissue defects of the forearm and hand were treated with osteocutaneous flaps (1992 to 2004) and evaluated for postoperative results. Assessment focused on range of motion, pain, grip strength, and Disabilities of Arm, Shoulder, and Hand questionnaire score. Donor- and recipient-site morbidity was documented.


RESULTS
The defects resulted from trauma, infection, or malignancy. Reconstruction was possible by microvascular osteoseptocutaneous fibula transplantation (n = 8), osteocutaneous scapular or parascapular flaps(n = 6), and osteocutaneous lateral arm flap (n = 1). The average patient age was 38 years. The median osseous defect was 11.7 cm, and all patients needed additional soft-tissue reconstruction. All defects could be reconstructed in a one-step procedure after serial débridement or oncologic resection. Patients' hand function was markedly reduced compared with the unaffected extremity, but functional results were still satisfactory, with a mean Disabilities of Arm, Shoulder, and Hand score of 25.3 reflecting a moderate disability in activities of daily living. Two patients developed pseudarthrosis, and one had to undergo an ablation procedure because of persistent infection. Two patients developed wound dehiscence at the donor site, and one patient required a fasciotomy due to an imminent compartment syndrome after fibula harvest. For all patients, the functional results were acceptable when the potential alternatives were taken into consideration. This was also reflected by a high individual satisfaction rate.


CONCLUSIONS
This analysis demonstrates that limb salvage with osteocutaneous free flaps is the treatment of choice for three-dimensional defects of the forearm and hand.
Kremer
Thomas
T
Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, The University of Heidelberg, Ludwigshafen, Germany.
Bickert
Berthold
B
Germann
Günter
G
Heitmann
Christoph
C
Sauerbier
Michael
M
D016025:Bone Transplantation / Q000379:methods; D004185:Disability Evaluation; D005542:Forearm / Q000601:surgery*; D006225:Hand / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008866:Microsurgery; D010146:Pain; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013524:Surgical Flaps; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*