Functional impairment following trauma or surgery may include impaired range of motion, problems with weight bearing, and loss of strength. These issues often require a complex treatment plan to correct. The causes for these issues range from bone loss, muscle loss, scar tissue, retraction of muscle, inadequate soft tissue coverage, and other complications – each of which must be addressed.
The surgeons at the Penn Orthoplastic Limb Salvage Center specialize in microsurgery, a type of surgery that requires the use of specialized microscope technology and precision tools to perform intricate operations on tiny structures such as tissue and blood vessels.
For patients dealing with functional limitations following trauma reconstruction, microsurgery enables surgeons to resolve these complex issues, and restore form and function to patients impaired by disease, trauma, or suboptimal surgical results.
Depending on your specific case, our surgical team may opt for one of the following treatment options.
Soft Tissue Revision
Using microvascular surgery, Penn surgeons are able to repair soft tissue defects that may have occurred due to free flap failures performed in previous surgeries.
Especially found in patients following joint replacements, revision microvascular surgery aims to repair soft tissue defects that have exposed bone, tendons, nerves, vessels, hardware, or soft tissue that has persistent infection that does not clear up.
Proper soft tissue reconstruction is a vital factor of limb sparing surgery. Through advances in microsurgery, Penn surgeons are able to correct soft tissue complications with better outcomes and improved cosmetic appearances.
Microvascular Free Tissue Transfer (Free Flaps)
Free tissue transfer or flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site. Free flaps are used to provide blood supply, tissue, and sensation to the injured site.
In cases where there are functional issues of a limb, free flap transfer may be the recommended option.
There are various types of flaps. Your surgeon will determine which type of flap is appropriate for your limb restoration.
- Free skin flap
- Free muscle flap
- Free vascularized bone flap
- Periosteal flap
Microvascular Scar Revision
Scar tissue that develops over time may interfere with range of motion, movement of muscle, and may cause pain. It is important that scar tissue is removed in order to address these issues and restore the strength and proper range of motion in your limb.
At Penn, our surgeons connect tissue and blood vessels using microvascular techniques to transplant tissue during your scar revision. Your surgeon will discuss this option with you in detail so you know what to expect.
Nerve Transfer Microsurgery/Total Muscle Innervation for Nerve Pain
Penn offers the latest advancements in nerve reconstruction surgical methods to ensure optimal outcomes and patient satisfaction for those who are experiencing impaired mobility or pain due to an injured limb.
Nerve transfer microsurgery is essentially a re-wiring of a nerve to eliminate pain or restore function and sensation. The nerve is taken from another part of your body and transplanted at the injury site. The transplanted nerve will grow and strengthen the connection between the brain and the injury site. Within time, the nerve transfer will restore communication between the brain and limb and should restore function.
The same technique applies to total muscle innervation where a nerve is transplanted into muscle fiber, innervating the muscle, bringing function and sensation.
These types of procedures may also be useful for amputees who suffer from phantom limb pain.