[Early microsurgical reconstruction of extremities with free microvascular flaps]

Abstract

The key to successful reconstruction of the extremities after complex trauma is often adequate soft tissue cover of the injured area. In the past, when surgical debridement of wounds was too extensive, or it exposed vital structures such as blood vessels, nerves, tendons or bones, the limb either had to be amputated or reconstructed in multiple surgical procedures. The use of free microvascular flaps in the immediate postinjury period allows single stage reconstruction of wounds including exposed vital tissues. It promotes limb salvage and shortens recovery time after severe trauma. 4 patients with severe complex trauma of the extremities underwent reconstruction with immediate free microvascular flaps, which included latissimus dorsi and rectus abdominis muscle and free scapular flaps. The surgical protocol included debridement of wounds on arrival with primary fixation of fractures and additional debridement procedures in the first week until the wound was stable. Then final fixation of fractures was performed and the wound was covered by a free microvascular flap. With this technique, single stage reconstruction is possible in most cases, with improvement in function and cosmetic outcome, multiple operations are avoided and the recovery period is shortened.