Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

BACKGROUND: Upper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity. METHODS: A literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available). RESULTS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation. CONCLUSIONS: With the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.

A preliminary pathological study on human allotransplantation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the survival of hand allograft under the state of immunosuppression and the pathological changes of rejection in the recovery process.</p><p><b>METHODS</b>The biopsies of the skin, nerve, muscle, tendon and bone tissue of hand allografts during different stages from 1 day to 7 months after operation were observed using routine histological technique.</p><p><b>RESULTS</b>No significant changes due to rejection in skin, nerve, muscle and bone tissue were observed. But different degrees of weak rejective changes were found on the wall of blood vessels; in the muscle and nerve the reactions were markedly stronger than those found in skin tissues.</p><p><b>CONCLUSIONS</b>The rejection in deep tissues should be monitored in controlling the rejection of hand allograft.</p>

Psychological consequences derived during process of human hand allograft / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To study the psychology and the treatment during the process of hand allograft.</p><p><b>METHODS</b>The patients were interviewed to evaluate their states of mind and their abilities to manage stress during the selection of patients. The psychology of the two patients were trained before the operation and managed accordingly afterwards.</p><p><b>RESULTS</b>One of 12 candidates was found to be unsuitable for the transplantation because of psychiatric problems. One week postoperatively, the two patients were anxious, lacked patience and were afraid of seeing the long-awaited grafted hand. After 1 week, the patients began to accept the new hand, with full acceptance of the hand 1 month later. With the recovery of hand sensation 4 to 5 months after the operation, the patients regarded the hand as their own.</p><p><b>CONCLUSION</b>Psychological problems exist during preoperative selection of patients and postoperative rehabilitation, requiring psychologists in the hand transplantation team.</p>