title: Pushing the Boundaries of Salvage in Mutilating Upper Limb Injuries: Techniques in Difficult Situations.
abstract: With the available microsurgical techniques, salvage of the limb can almost always provide a useful upper limb, even in the most complex combined injuries. Having a low threshold for revascularization of doubtfully viable extremities and making full use of the current armamentarium of soft tissue cover techniques, including flow through free flaps, will salvage many limbs. Secondary procedures, including free functioning muscle transfers and toe transfers, further increase the possible functional outcome. Even in the most complex combined injuries, intelligent reconstruction will obtain better outcomes than the best available prosthesis, making the efforts of salvage worthwhile.
authors.affiliation: Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India. Electronic address: rajahand@gmail.com.
authors.forename: S Raja
authors.initials: SR
authors.lastname: Sabapathy
authors.affiliation: Department of Plastic Surgery, St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Court Road Broomfield, Chelmsford, Essex CM1 7ET, UK.
authors.forename: David
authors.initials: D
authors.lastname: Elliot
authors.affiliation: Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India.
authors.forename: Hari
authors.initials: H
authors.lastname: Venkatramani
mesh_terms: D001134:Arm Injuries / Q000601:surgery*; D058752:Free Tissue Flaps; D006230:Hand Injuries / Q000601:surgery; D006801:Humans; D008488:Medical Illustration; D008866:Microsurgery / Q000379:methods*; D010781:Photography; D019651:Plastic Surgery Procedures / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation*; D034941:Upper Extremity / Q000098:blood supply
keywords: Bilateral upper limb amputation; Flow through free flap; Free functioning muscle transfer; Mutilating hand injuries; Toe transfers