Microvascular soft tissue reconstruction surgery
Good quality skin cover of the hand and wrist is essential for good function. Good skin cover can be missing after trauma, infection, removal of cancer or other wound problems.
Reconstructing soft tissue cover that is functional and aesthetically acceptable is one of the key skills of a plastic and reconstructive surgeon.
Some defects can be reconstructed with the use of skin grafts or by rearranging locally available skin. Complex defects may require a complex solution, such as microsurgery. This can include transferring soft tissue (skin, fat, fascia and / or muscle) with its blood vessels from one part of the body (donor site) and connecting it to the blood supply at the defect (recipient site) using a microscope.
Microvascular tissue transfers
Microsurgical transfer of full thickness skin (free fasciocutaneous flap) can be used to bring good quality skin with it's own blood supply from a donor site to the defect site. A skin flap is stronger and aethetically better than a skin graft.
Other tissues types can be used to reconstruct various defects. For example, an expendable thigh muscle can be used to bring functional muscle to the forearm to restore active finger flexion (free functional muscle flap reconstruction).
If a large segment of bone is missing from the forearm, a bone from the leg with it's own blood supply can be inserted to provide durable stability (free bone flap reconstruction).