{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T09:45:51Z","timestamp":1778751951574,"version":"3.51.4"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T00:00:00Z","timestamp":1650412800000},"content-version":"vor","delay-in-days":1876,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2017,3,15]],"date-time":"2017-03-15T00:00:00Z","timestamp":1489536000000},"content-version":"tdm","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.e-aps.org"],"crossmark-restriction":true},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:p>\n          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.<\/jats:p><jats:p>\nMethods  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).<\/jats:p><jats:p>\n          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.<\/jats:p><jats:p>\nConclusions  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.<\/jats:p>","DOI":"10.5999\/aps.2017.44.2.117","type":"journal-article","created":{"date-parts":[[2017,3,23]],"date-time":"2017-03-23T01:37:37Z","timestamp":1490233057000},"page":"117-123","update-policy":"https:\/\/doi.org\/10.5999\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity"],"prefix":"10.1055","volume":"44","author":[{"given":"Zhi Yang","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaun Shi Yan","family":"Tan","sequence":"additional","affiliation":[{"name":"Royal College of Physicians and Surgeons of Glasgow, Scotland, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre Gaston","family":"Lellouch","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Curtis Lisante","family":"Cetrulo","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harvey Wei Ming","family":"Chim","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1097\/00005373-197412000-00002","article-title":"Treatment of open crushing type of industrial injuries of the hand and forearm: degloving, open circumferential, heat-press, and nail-bed injuries","volume":"14","author":"T Tajima","year":"1974","journal-title":"J Trauma"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0020-1383(97)00011-9","article-title":"Revascularization of degloving injuries of the limbs","volume":"28","author":"S Waikakul","year":"1997","journal-title":"Injury"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.injury.2013.01.025","article-title":"A new classification to aid the selection of revascularization techniques in major degloving injuries of the upper limb","volume":"44","author":"S Lo","year":"2013","journal-title":"Injury"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/PRS.0b013e31829ad012","article-title":"Timing of traumatic upper extremity free flap reconstruction: a systematic review and progress report","volume":"132","author":"BL Harrison","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1097\/01.prs.0000204959.18136.36","article-title":"Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures","volume":"117","author":"BM Parrett","year":"2006","journal-title":"Plast Reconstr Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s11751-010-0090-z","article-title":"Upper extremity resurfacing via an expanded latissimus dorsi musculocutaneus flap for large circumferential defects: the \u201cspiral\u201d reconstruction technique","volume":"5","author":"S Nazerani","year":"2010","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.bjps.2011.06.042","article-title":"Treatment of giant congenital melanocytic nevus of the left upper extremity with staged expanded flap","volume":"65","author":"Y Liu","year":"2012","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1016\/j.bjps.2016.08.024","article-title":"Expanded bi-pedicled \u201csleeve\u201d flap for reconstruction of the upper extremity after large circumferential nevus excision in children","volume":"69","author":"Y Shachar","year":"2016","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"e150","DOI":"10.1308\/rcsann.2016.0195","article-title":"Total reconstruction of giant congenital circumferential nevi of the upper limb using a large pedicle expanded flank flap: a brief report","volume":"98","author":"JP Ding","year":"2016","journal-title":"Ann R Coll Surg Engl"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1177\/1558944715614854","article-title":"Elbow reconstruction with compression plate arthrodesis and circumferential muscle-sparing latissimus dorsi flap after tumor resection: a case Report","volume":"11","author":"ZY Ng","year":"2016","journal-title":"Hand (N Y)"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/229255030401200205","article-title":"Lymphedema of the upper extremity following circumferential burns","volume":"12","author":"C Balakrishnan","year":"2004","journal-title":"Can J Plast Surg"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1097\/PRS.0000000000000508","article-title":"The volar forearm fasciocutaneous extension: a strategy to maximize vascular outflow in post-burn injury hand transplantation","volume":"134","author":"KR Eberlin","year":"2014","journal-title":"Plast Reconstr Surg"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/0305-4179(90)90076-9","article-title":"Electrical injury of wrist: classification and treatment: clinical analysis of 90 cases","volume":"16","author":"ZY Shen","year":"1990","journal-title":"Burns"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1016\/j.burns.2013.04.014","article-title":"Combined rectus abdominis muscle\/paraumbilical flap and lower abdominal flap for the treatment of type III circumferential electrical burns of the wrist","volume":"39","author":"XH Hu","year":"2013","journal-title":"Burns"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/S0363-5023(77)80099-3","article-title":"Reconstructive surgery of roller injuries of the hand","volume":"2","author":"MV Sanguinetti","year":"1977","journal-title":"J Hand Surg Am"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1097\/00000637-199710000-00006","article-title":"Resurfacing a circumferentially degloved hand by using a full-thickness skin graft harvested from an avulsed skin flap","volume":"39","author":"SF Jeng","year":"1997","journal-title":"Ann Plast Surg"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1002\/micr.20603","article-title":"Resurfacing of a complex upper extremity injury: an excellent indication for the dorsal thoracic fascial flap","volume":"29","author":"R Hazani","year":"2009","journal-title":"Microsurgery"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s11552-009-9187-6","article-title":"Omental free-tissue transfer for coverage of complex upper extremity and hand defects: the forgotten flap","volume":"4","author":"IA Seitz","year":"2009","journal-title":"Hand (N Y)"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.bjps.2013.10.007","article-title":"Multiple-digit resurfacing using a thin latissimus dorsi perforator flap","volume":"67","author":"SW Kim","year":"2014","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1055\/s-0035-1544165","article-title":"Approach to complex upper extremity injury: an algorithm","volume":"29","author":"ZY Ng","year":"2015","journal-title":"Semin Plast Surg"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/00007611-197803000-00024","article-title":"Multiple flap coverage for degloving hand injuries","volume":"71","author":"NJ Cowen","year":"1978","journal-title":"South Med J"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/00006534-198803000-00006","article-title":"The use of free flaps in burn patients: experiences with 70 flaps in 65 patients","volume":"81","author":"TY Shen","year":"1988","journal-title":"Plast Reconstr Surg"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/0363-5023(88)90193-1","article-title":"Emergency free flaps to the upper extremity","volume":"13","author":"G Lister","year":"1988","journal-title":"J Hand Surg Am"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/j.burns.2010.05.007","article-title":"Use of multiple VAC devices in the management of extensive burns: the total body wrap concept","volume":"36","author":"SJ Chong","year":"2010","journal-title":"Burns"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1016\/j.burns.2013.03.010","article-title":"The enhanced total body wrap: the new frontier in dressing care for burns","volume":"39","author":"OW Low","year":"2013","journal-title":"Burns"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.burns.2015.08.034","article-title":"Extra-large negative pressure wound therapy dressings for burns: initial experience with technique, fluid management, and outcomes","volume":"42","author":"S Fischer","year":"2016","journal-title":"Burns"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1097\/01.smj.0000217111.35160.09","article-title":"Management of a circumferential lower extremity degloving injury with the use of vacuum-assisted closure","volume":"99","author":"LK Wong","year":"2006","journal-title":"South Med J"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"79","DOI":"10.12968\/jowc.2009.18.2.38747","article-title":"Circumferential application of VAC on a large degloving injury on the lower extremity","volume":"18","author":"MG Barendse-Hofmann","year":"2009","journal-title":"J Wound Care"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1016\/j.burns.2016.06.011","article-title":"A review of negative-pressure wound therapy in the management of burn wounds","volume":"42","author":"NA Kantak","year":"2016","journal-title":"Burns"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.burns.2003.12.003","article-title":"Use of subatmospheric pressure therapy to prevent burn wound progression in human: first experiences","volume":"30","author":"LP Kamolz","year":"2004","journal-title":"Burns"},{"key":"ref31","first-page":"17","article-title":"Integra in burns reconstruction: our experience and report of an unusual immunological reaction","volume":"27","author":"P Lohana","year":"2014","journal-title":"Ann Burns Fire Disasters"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"2934","DOI":"10.2106\/JBJS.J.00258","article-title":"Traumatic and trauma-related amputations: Part II: Upper extremity and future directions","volume":"92","author":"SM Tintle","year":"2010","journal-title":"J Bone Joint Surg Am"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1097\/00006534-198512000-00021","article-title":"The posterior calf fascial free flap","volume":"76","author":"RL Walton","year":"1985","journal-title":"Plast Reconstr Surg"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1111\/j.1742-481X.2011.00787.x","article-title":"A reliable method of applying a circumferential dressing","volume":"8","author":"SA Mashhadi","year":"2011","journal-title":"Int Wound J"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1097\/01.sap.0000100896.87833.80","article-title":"Large and giant congenital pigmented nevi of the upper extremity: an algorithm to surgical management","volume":"52","author":"A Margulis","year":"2004","journal-title":"Ann Plast Surg"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1097\/TP.0b013e3181ff1472","article-title":"The international registry on hand and composite tissue transplantation","volume":"90","author":"P Petruzzo","year":"2010","journal-title":"Transplantation"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.e-aps.org\/upload\/pdf\/aps-44-117.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.e-aps.org\/journal\/view.php?doi=10.5999\/aps.2017.44.2.117","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.5999\/aps.2017.44.2.117.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T23:17:58Z","timestamp":1650496678000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.5999\/aps.2017.44.2.117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3]]},"references-count":36,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2022,4,20]]},"published-print":{"date-parts":[[2017,3]]}},"URL":"https:\/\/doi.org\/10.5999\/aps.2017.44.2.117","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3]]},"assertion":[{"value":"2016-09-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-02-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-03-15","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-03-15","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}