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Bolletta et al. Plast Aesthet Res 2019;6:22 Plastic and
DOI: 10.20517/2347-9264.2019.22 Aesthetic Research

Review Open Access

Advances in microsurgery for upper and lower
extremity reconstruction and limb preservation

Alberto Bolletta , Rubino Corrado , Hung-Chi Chen 1
2
1,2
1 Department of Plastic Surgery, China Medical University Hospital, Taichung 404, Taiwan.
2 Department of Medical, Surgical and Experimental Sciences, UHT of Sassari, Plastic Surgery Unit, University of Sassari, Sassari
07100, Italy.
Correspondence to: Dr. Hung-Chi Chen, Department of Plastic Surgery, China Medical University Hospital, 2 Yude Road, Taichung
404, Taiwan. E-mail: d19722@mail.cmuh.org.tw
How to cite this article: Bolletta A, Corrado R, Chen HC. Advances in microsurgery for upper and lower extremity reconstruction
and limb preservation. Plast Aesthet Res 2019;6:22. http://dx.doi.org/10.20517/2347-9264.2019.22
Received: 1 Sep 2019 First Decision: 1 Oct 2019 Revised: 15 Oct 2019 Accepted: 17 Oct 2019 Published: 24 Oct 2019

Science Editor: Matthew L. Iorio Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract

In the recent decades, microsurgical reconstruction has evolved from simple survival of the affected extremity to
the improvement of functional and aesthetic outcome. This review retraces the main contributions to the advances
of microsurgery for reconstruction of upper and lower extremities and limb preservation. In the upper extremity,
it is important to restore fine motility, together with allowing prompt mobilization. In the lower limb, care must be
taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe wearing. Local
perforator flaps can be considered for medium size defects. They provide thin coverage and can be performed in short
operating time. Their use, though, is often limited by tissue availability. Free flaps allow to overcome this problem
and, thanks to the recent development in the study of perforator vessels, the microsurgeon can choose the flap
with the most appropriate characteristics. Chimeric flaps can accomplish simultaneous reconstruction of different
tissue components and large bone defects often require vascularized bone reconstruction. When dealing with limb
preservation it is very important to consider residual functionality. Functioning muscle transfer and targeted muscle
re-innervation can be performed in these cases. A useful reconstructive tool in severely damaged limbs with limited
blood supply is the use of cross-leg free flaps. In conclusion, extremity reconstruction and limb preservation are
reaching new heights thanks, not only to the work of plastic surgeons, but also to the new developments in other
fields of study such as oncology, traumatology, radiology and medical engineering.

Keywords: Extremity reconstruction, functional and aesthetic outcome, limb salvage, perforator flaps, free flaps,
weight-bearing areas, cross-leg flaps

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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