The Development and Future of Reconstructive and Microvascular Surgery of the Hand

Marco Malahias 1, Daniel J Jordan 2, Sandip Hindocha*, 2, Wasim Khan 3, Ali Juma 4
1 Plastic Surgery Department, Good Hope Hospital, West Midlands, UK
2 Plastic Surgery Unit, Whiston Hospital, Liverpool, UK
3 Royal National Orthopaedic Hospital, London, UK
4 Plastic Surgery Unit, Countess of Chester Hospital, Chester, UK

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© Malahias et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Plastic Surgery, Whiston Hospital, Liverpool, UK L35 5DR, UK; Tel: + 44(0)1244366265; Fax: +44(0)1244366265; E-mail:


The hand is often thought of as a key discriminator in what makes humans human. The hand is both intricate and fascinating in its design and function, allowing humans to interact with their surroundings, and each other. Due to its use in manipulation of the person’s environment, injury to the hand is common.

Devastating hand injuries have a profound, physical, psychological, financial and socially crippling effect on patients.

Advances in operative techniques and improvements in microscopes and instruments allowed Malt &McKhann to perform the first successful arm replantation in 1962 [1].

This was followed by a myriad of autologous free flaps of varying composition, that were discovered after the mapping of the cutaneous blood circulation by Taylor and Palmer [2] and Mathes &amp&#x003B; Nahai’s classification of muscle flaps [3] providing us with countless options to harvest and transfer healthy, well vascularised tissues into areas of injury.

Since the late sixties, with the emerging subspecialty of microvascular reconstruction, surgeons have had the technical ability to salvage many amputated parts, even entire limbs.

The measure of functional outcomemust incorporate the evaluation and severity ofthe initial injury and the subsequent reconstructive surgeries [4].

Keywords: Free tissue transfer, hand injuries, microsurgery, upper limb reconstruction..