Director Dr. Arik Zaretski

General Description

The Unit for Reconstructive Plastic Surgery of the Limbs offers a variety of treatment methods to preserve an injured limb and maximize normal functioning, through advanced treatment techniques.

Among others, the service treats patients with limb injuries resulting from trauma, tumors in the bone and soft tissue, etc.

Surgery is conducted in cooperation with the National Unit of Oncological Orthopedics and Departments of Orthopedics in the Tel Aviv Sourasky Medical Center.

Microsurgery in procedures to save limbs:

Various techniques of microsurgery have greatly contributed to limb preservation. By transferring tissue from one area in the body to another it is possible to reconstruct areas with full or partial deficit of bone or soft tissue such transfer of functional muscles - reconstructing the movement ability of the limb, Avascular Necrosis.

The development of microsurgery enabled the implementation of limb-preserving surgery, while maintaining a bone that might have required amputation.

Microsurgery is also used to transfer soft tissue to cover wounds or open fractures on the limbs when it is not possible to use local tissue, such as the lower area of the calf.

Additional uses for free flaps:

1. Biological reconstruction of joints - transferring bone sections, including the joint
2. Transfer of functional muscles - reconstructing the movement ability of the limb
3. Avascular Necrosis

Preservation of Limbs in Oncological Surgery

Until the 1970s, amputation of the infected limb was the conventional treatment for malignant growths on the limbs. More effective chemotherapy and the development of microsurgery enabled the implementation of limb-preserving surgery, while maintaining oncological principles.

The main tasks of the staff in oncological orthopedics:

1. Replacement of bone sections that have been removed, with a live bone taken from the patient's body
2. Reconstruction of soft tissue and covering of important anatomical structures, such as bones, blood vessels and nerves.
3. Covering exposed metal implants

Preservation of Limbs Following Trauma:

The main causes of severe trauma to limbs are road and work accidents, and war injuries.

In the case of severe trauma to the limbs, patients generally suffer:

1. Osseous trauma - fractures, open fractures, crushed fractures and, in some cases, a missing bone.
2. Trauma to the soft tissues (muscles, skin, etc.) that might be severe.
3. Trauma to nerves and the blood supply to the limb

In cases of trauma, the level of damage to the soft tissue might be more severe than in other cases of injury. Typical cases are Avulsion Injury and widespread injury to the muscles. A common problem in such cases is the damage to blood vessels, making microsurgical connection of the free flaps very difficult.

The Main Free Flaps Used in Microsurgery:

Soft Tissue: gracilis muscle (muscle on the inner thigh), latissimus dorsi (muscle on the back), rectus abdominis (muscle on the stomach) and vastus lateralis (muscle from the thigh).

Skin and fat: Anterolateral Thigh Flap (ALT), Radial Forearm Free Flap (RFFF).

Bone: Fibula Flap - the most useful flap, which can be used with extra skin, muscle and fascia.

The post-surgery recovery period is one-two weeks, during which the patient is hospitalized in our department. Rehabilitation continues at home, until a return to full daily functioning.