Primary and secondary microvascular reconstruction of the upper extremity

Tissue defects of the upper extremity may result from trauma, tumor resecti on, infection, and congenital malformation. Restoration of anatomy and func tional integrity may require microsurgical free flap transfer for coverage of bones, nerves, blood vessels, or tendons. Microsurgical tissue transfer also may be required prior to secondary reconstruction, such as tendon tran sfers or nerve or bone grafts. This article addresses indications for upper extremity reconstruction using microsurgical tissue transfer flap selectio n and strategies including primary and secondary reconstruction.