The role of microsurgery and free tissue transfer in the reconstruction of the paediatric upper extremity.

A review of the role of microvascular autotransplantation in reconstructive surgery of the paediatric upper limb is presented. Such techniques bring versatility to reconstruction of the upper limb that has previously not been available. In particular they offer the opportunity for transplantation of skin flaps in one stage, and the transplantation of vascularised joints and growth centres. Most importantly however, they offer the opportunity to reconstruct digits by transplantation of homologues from the foot. The surgical techniques are complex but reliable, and we place emphasis upon the value of the specialised care team and the counselling of families and patients. This also has the benefit of minimising the morbidity of these procedures to a level that is equal to or better than their conventional alternatives.