The management of complex upper limb trauma

While in the lower limb, the orthopedic and plastic surgeon can handle together the difficult cases, in the upper limb the complex trauma is solved by the hand surgeon. The multi-tissue problems may be faced only with a systematic reconstructive plan through strong orthopedic knowledge about bone fixation, biomechanical and tendon function, joint replacement experiences and nerve regeneration related to plastic instruction concerning skin healing, flap coverage and microsurgical knowledge. These competences are summarized in the figure of hand surgeon who handled a combined injury involving three or four tissue type lesions. In this manuscript, we will summarize the principal steps of the management of upper limb trauma, considering initial assessment, decision making process and reconstructive ladder principles.