Complex defects of the forearm and hand often require microvascular reconstruction with osteocutaneous free flaps for limb salvage. The purpose of this was study was to evaluate the functional outcomes after forearm and hand reconstruction with free microvascular composite osteocutaneous flaps. Fifteen patients with combined osseous and soft tissue defects of the forearm and hand were treated with osteocutaneous flaps between 1992 and 2004 and were examined to evaluate the postoperative results. The assessment focused on the range of motion, pain and strength as well as on the patients ADL`s measured with the DASH-questionnaire. Additionally the length of hospitalization, number of complications, the return to work and the morbidity at the donor site were noted. Reasons for the complex defects were trauma, infections or malignant tumors. Eight free microvascular osteoseptocutaneous fibula transplantations were performed, six patients were treated with osteo (myo-) cutaneous scapular or parascapular flaps. In one patient an osteocutaneous lateral arm flap was used for thumb reconstruction. The patients average age was 40,6 years (range; 13 to 67 years), mean duration of hospitalisation was 41 days (range 18 to 73 days). The average osseous defect was 11,7 cm (range 2 to 21 cm), all patients suffered from additional soft tissue defects of different dimensions. All defects could be definitely reconstructed. Every patient had a markedly reduced functional outcome of the hand compared with the unaffected extremity, but in all but one patient the functional result was satisfying. The mean DASH score was 21,8 (range 0 to 42) and reflects only a moderate disability of the reconstructed arm, especially with respect to the complex clinical situation. Two patients developed a nonunion. One patient had to undergo an amputation due to persistent infection. Two patients suffered from wound dehiscence at the donor site, one patient needed a fasciotomy because of an imminent compartment syndrome at the donor site. From the patients point of view with the potential alternatives taken into consideration these results were more than acceptable. This was also reflected by a high individual satisfaction and the comparably low DASH score. Our results clearly demonstrate that salvage of the forearm and hand with osteocutaneous free flaps is the treatment of choice instead of ablation or the employment of Ilizarov technique.
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