Purpose: Complex defects of the forearm and hand often require microvascular reconstruction with composite osteocutaneous free flaps for limb salvage. Here, a postoperative outcome analysis of 15 patients is presented, who were treated by free composite tissue transplantation between 1992 and 2004 in a single institution.
Patients and methods: The assessment focused on the range of motion, the pain and grip strength as well as on the patient's individual physical functioning and self perception, measured with the DASH questionnaire. Additionally complications, return to work and the donor site morbidity were documented.
Results: Reasons for the combined defects were trauma, infections or malignant tumors. The patients' average age was 38 years. The average osseous defect was 11.7 cm (range, 6 to 21 cm), all patients suffered from additional soft tissue defects. Microvascular osteoseptocutaneous fibula transplantations (n = 8), osteocutaneous scapular or parascapular flaps (n = 6) and osteocutaneous lateral arm flaps were performed for reconstruction. The mean hospitalisation time was 39.3 days (range, 18 - 73 d). All defects could be reconstructed in a one-step reconstructive procedure after sequential debridements or after radical tumour resection. Two patients developed a pseudarthrosis, one had to undergo an ablation procedure due to persistent infection; however, the flap was well perfused. Every patient had a markedly reduced hand function compared with the unaffected extremity, however the functional results were satisfactory with a mean DASH score of 25.3 (range, 0 to 42). This reflects only a moderate disability in activities of daily living. From the patients' point of view the functional results were more than acceptable when the potential alternatives were taken into consideration. This was also reflected by a high individual satisfaction.
Conclusion: This retrospective analysis demonstrates that limb salvage with osteocutaneous free flaps is an important tool in the armamentarium for the treatment of composite defects in the forearm and hand. Functional results are good and the patient's high individual satisfaction justifies the use of these difficult reconstructive procedures.