title: Free vascularized tissue transfer to preserve upper extremity amputation levels.
abstract: BACKGROUND
  Free vascularized tissue transfer to preserve upper extremity amputation level is an uncommon procedure. The authors investigate the role of free tissue transfer in preserving both morphology and function of the amputated upper extremity, with the goal of facilitating prosthetic rehabilitation.
  
  
  METHODS
  Thirteen patients who underwent microsurgical free tissue transfer to preserve upper extremity amputation level were reviewed retrospectively. These cases were selected from four centers: Duke University Medical Center (Durham, N.C.) University Hospital of Modena (Modena, Italy), Careggi University Hospital (Florence, Italy), and the University of Heidelberg (Heidelberg, Germany). Parameters that were evaluated included age, sex, cause of the defect, reconstructive procedure, structures to be salvaged, and functional outcome, among others.
  
  
  RESULTS
  The cause of amputation was trauma in 92 percent of patients. Mean age was 32 years. In 31 percent of the cases, an emergency free fillet flap was used, and in the remaining 69 percent, a traditional free flap was performed. Structures/function to be preserved included pinch function to the hand, function of the elbow and shoulder joints, and skeletal length greater than 7 cm. Complications occurred in 38 percent of the cases, but the final goal of the procedure was achieved in all cases. A treatment algorithm for the management of the amputated upper extremity is presented.
  
  
  CONCLUSIONS
  Use of free vascularized tissue transfer for preservation of upper extremity amputation level in well-selected cases facilitates prosthetic rehabilitation and improves residual limb function.
authors.affiliation: Durham, N.C.; Modena and Florence, Italy; and Heidelberg, Germany From the Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Duke University Medical Center; Division of Plastic and Reconstructive Surgery, University of Modena and Reggio Emilia; Division of Reconstructive Microsurgery, Careggi University Hospital; and Department of Plastic, Reconstructive, and Hand Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg.
authors.forename: Alessio
authors.initials: A
authors.lastname: Baccarani
authors.forename: Keith E
authors.initials: KE
authors.lastname: Follmar
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Santis
authors.forename: Roberto
authors.initials: R
authors.lastname: Adani
authors.forename: Massimo
authors.initials: M
authors.lastname: Pinelli
authors.forename: Marco
authors.initials: M
authors.lastname: Innocenti
authors.forename: Steffen
authors.initials: S
authors.lastname: Baumeister
authors.forename: Henning
authors.initials: H
authors.lastname: von Gregory
authors.forename: Günter
authors.initials: G
authors.lastname: Germann
authors.forename: Detlev
authors.initials: D
authors.lastname: Erdmann
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D000672:Amputation Stumps / Q000601:surgery*; D001134:Arm Injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome