Enrico Martin

196 Chapter 8 Hand and wrist Defects after STS in hand and wrist area are diverse and according to each specific deficit three different studies describe their reconstructions performed in 13 patients. 13,35,36 One study specifically reported on thumb reconstructions after STS. 35 These were commonly reconstructed with tendon transfers, but a successful toe-to- thumb reconstruction has also been described. On average, high MSTS scores were yielded (95.2%). Other deficits of the hand occurred after tendon resections or resection of digital nerves. Tendon defects of other fingers could often be reconstructed with the use of allografts or tendon transfers. 13,36 Functional results were variable, but of the three unfavorable outcomes, one was related to tendon rupture. 13 Digital nerve defects and median nerve defects were reconstructed with the use of sural nerve grafts or lateral antebrachial cutaneous nerve grafts. 35,36 In one study, no neuropathic pain was observed after nerve reconstruction. 36 No other sensibility outcome measures were described. No study reported cases of nerve transfers used to restore sensation in the hand. Upper leg and hip Eight studies reported a total of 89 patients with reconstructions of upper leg and hip functions ( Table 3 ). After resection of the complete hamstrings, knee flexion was regained with the use of free innervated LD flaps, resulting in good functional outcomes (M3-4, MSTS 63.3-86.7%). 31,33 One patient did not regain active knee flexion (M2) which resulted in the use of a static knee brace and the lowest MSTS score (63.3%). 33 Loss of knee extension function was most commonly reconstructed with a free LD flap as well, but a gracilis or sartorius tendon transfer was concomitantly performed in cases with complete quadriceps resection. 33,37 Outcomes were variable ranging from M2-5. A total of 3/17 patients did not regain more than M2 muscle power, most of which resulted in a fair MSTS score. In one patient with flap failure, knee extension was completely absent and a poor MSTS score was observed. 37 Two studies evaluated the effect of a contralateral composite ALT flap, which showed good muscle grade (M4-5) and reasonable MSTS scores (63.3-80%). 34,38 A free rectus femoris flap, transverse abdominal muscle flap (TRAM), and free gracilis flap have also been described all of which yielded high functional outcomes (M4-5, MSTS 100%). 31 Tendon transfers using the biceps femoris tendon for reconstruction of knee extension have been described in one study which resulted in an M4 muscle grade on average. 39 These tendon transfers sometimes included a gracilis or semitendinosus tendon as well, depending on surgeon preference. However, such additional tendons did neither increase power nor functionality, but did increase wound dehiscence and lymph edema rates. 39 Adductor muscles of the leg were reconstructed using either a free LD, free gracilis, or a free rectus abdominis flap. 31,33 All of which regained reasonable to excellent muscle power (M3-5) and good MSTS scores (86.7-96.7%). Reconstruction of the gluteal muscle after STS resection has also been described in one study. 31 Either a free LD flap or TRAM was used, both resulting in M5 hip extension and 100% MSTS scores. Sciatic nerve