Neil F. Jones, MD Guest Editor

Three previous issues of Hand Clinics have been devoted to microsurgical reconstruction of the upper extremity over the past 22 years: the first in 1985 edited by James Urbaniak, MD; the second in 1992 edited by Michael Wood, MD; and the last in 1999 edited by Fu-Chan Wei, MD. So the time has come for a fourth issue, focusing on microsurgery. Microvascular and mi-croneural techniques are arguably the most significant advances in hand surgery and will potentially lead to even more exciting advances in the application of composite tissue transplantation and tissue engineering in the upper extremity. After the tremendous explosion in microsurgery in the upper extremity in the 1970s and 1980s, the succeeding generation of reconstructive hand surgeons now achieves success rates of greater than 95% to 97% and continues to refine the functional and esthetic results.

The results of microsurgical replantation are immediately gratifying to both patient and surgeon, but the salvage of devastating injuries of the upper extremity with free flaps for soft tissue coverage, or limb salvage after tumor resection with vascularized bone transfers, or rehabilitation of compartmental muscle loss or brachial plexus injuries with nerve transfers or functional muscle transfers are no less dramatic. Toe-to-hand transfers are perhaps the epitome of microsurgical reconstruction and confirm Sir Harold Gillies's admonition of ''replace like with like.'' Microsurgery has also allowed the parallel development of radical debridement and immediate single-stage reconstruction.

However, over the last few years, there has seemed to be a retrenchment among hand surgeons to adopt these powerful microsurgical techniques to provide patients with state-of-the-art reconstruction, possibly related to inadequate training, levels of reimbursement, and life style issues. This issue of Hand Clinics is therefore timely to showcase the indications for referral for microsurgical reconstruction. All of the principal authors have been selected because of their enormous wealth of experience, no better illustrated than by Harry Buncke, MD, ''the father of microsurgery in the United States,'' and because they continue to remain active ''in the

0749-0712/07/$ - see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.hcl.2007.03.001

trenches," getting up at night for replantations, and devoting many hours during the day to complex elective reconstructions.

Hopefully, the reader will marvel at the results that can now be achieved with refinements in microsurgical reconstruction in the twenty-first century and can therefore objectively compare whether conventional techniques or microsurgical techniques will produce the best result for their patient.

As the Guest Editor of this issue, I would like to thank all of the contributing authors for sharing their surgical philosophy and technical expertise, and I would also like to thank Deb Dellapena, Editor of Hand Clinics, for her determined tenacity in bringing this issue to fruition.

Neil F. Jones, MD UCLA Hand Center Department of Orthopaedic Surgery and Division of Plastic and Reconstructive Surgery University of California, Los Angeles 10945 LeConte Avenue, Suite #3355 Los Angeles, CA 90095, USA

E-mail address: [email protected]

Hand Clin 23 (2007) 1-12

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