While talking about reconstructive surgeries of the upper and lower limbs, many injuries, disorders and congenital deformities (fetal development defects) come into the picture. These could be fingers attached to each other or having an extra finger of the upper or lower limb, including the arm, forearm and hand, foot, toes etc. Upper limb composite tissue defects may result from trauma, tumour, or any other problems like resection (which means cutting) or even infection.
Rheumatoid arthritis or osteoarthritis may also cause deformed looking hand or leg. When reconstructing these defects, it is essential to provide adequate soft tissue protection of significant structures that are required for the functioning of hand like blood vessels which supply blood to the tissue and nerves and to provide maximum functional outcomes.
Reconstruction of soft tissue defects in the distal third of the leg (the part of the leg below the knee) is one of the most challenging in lower limb reconstruction. Usually, the low mobility of the surrounding skin does not make a direct closure possible for which other surgical treatments like skin grafting, local flaps and free flaps.
The development of clinical micro surgery has added a significant number of treatment options to surgeon primarily replantation of cut tissues and transplantation of vascularized tissues which have a prior blood supply from distant donor sites. Reconstructing the soft tissue of a damaged upper extremity presents unique challenges to the plastic surgeon. These procedures may involve sophisticated techniques such as microsurgery which deals with re creating a new blood supply for cut fingers or tissues of hand, soft tissue grafts, bone grafts, flaps, nerve transfer or tendon(the tissue that holds the muscle by getting attached to a bone) transfer.
- Bent/deformed hands, fingers, foot and toes. Can be a congenital issue or due to traumatic injury.
- Burns in the upper limbs and the lower extremity, such as the entire leg, foot etc.
- Carpal tunnel syndrome (nerve compression which leads to pain or numbness in your wrist, hand, forearm.)
- Cubital tunnel syndrome (numbness or pain due to nerve compression in the elbow)
- Joint dislocations (common injuries that force the ends of bones out of position)
- Fractures of the in the tarsals and metatarsals (long & short bones) hand, wrist, forearm, and the foot.
- Sports injuries
- Tendon cuts
The reconstruction of complex defects of the upper and lower limbs requires a thorough knowledge of extremity anatomy and function, as well as good surgical techniques. Functional and aesthetic concerns must be addressed to optimise the outcome, and no single surgical approach is sufficient for all defects. From a substantive point, soft-tissue coverage should protect the neuro vascular, musculoskeletal, and particular aspects of the hand, and allow unrestricted range of motion. Ideally, the soft-tissue envelope should be sensitive to touch and other sensations, durable, and able to withstand routine daily trauma. Also, because the hand and upper extremity are highly visible during social interactions, efforts should be made to provide a visibly acceptable result.
HOW MUCH TIME WOULD BE THERE TO REATTACH THE LIMB?
For the limb to be immediate functional surgery would be required, and maximum result is obtained if it’s done within six hours.
Revascularization which provides new blood supply to the damaged limb is critical for the success of limb salvage, a reconstructive treatment for trauma defects of the limbs. Even though about 95% of the injured limbs are successfully retrieved by early surgical intervention and revascularization, the results may not be excellent if the injury took place due to a war.
TYPES OF SURGERIES:
The best results can be achieved by reattaching the amputated original tissues which can be done by microsurgical replantation. In uninfected, uncontaminated traumatic injuries (which means clean wounds) resulting in composite soft tissue defects.
Early free flap reconstruction of the upper extremities has significant advantages over delayed type which means from 72 hours up to three months or another type of reconstruction called late wound closure from 3 months up to two years. In recent years, thin, pliable which means easy to handle, and versatile fascia cutaneous flaps such as thigh and arm flaps are mostly used with great success to repair the upper extremity. The use of functional reconstructions like ostomy cutaneous free flaps which mean muscle along with bone and skin are included in toe to thumb transfers the upper and lower limbs reconstructive micro surgery.