Coverage of the Severely Traumatized Extremity by Emergency Free Flap: Case Report

Emergency free flap has been advocated to cover the severely injured extremity for more than two decades, due to its numerous advantages such as low incidence of flap failure and infection rate and early recovery of function. But there are very few reports about these. The authors report their experience in using the emergency free flap for reconstruction of extremities. For last 10 years, 4 patients ranging from 3 to 27 years old with severely traumatized extremities were treated with emergency free flap transfers. Three were males and the other was a female. Flap size ranged from 2x5 cm2 to 7x22 cm2. The locations of the recipient site were the dorsum of the foot, the cubital fossa, the popliteal fossa and the upper arm. The number of the donor sites used was as follows: one scapular flap, two parascapular flaps, and one radial forearm flap with the radial bone. All of the flaps survived without need of re-exploration. There was no infection or flap loss. Involved joints have recovered a normal range of motion. Therefore, we consider that the emergency free flap is a very safe and reliable method to cover the severely injured extremities.

Emergency Free Flap Transfer for Deep Burn and Severe Crushing Injury of Dorsum of the Hand

The accepted method in treating deep burns and severe crushing injuries of dorsum of the hand is serial debridement and delayed closure. Delayed wound closure with skin graft, local flap or regional pedicle flap may produce joint stiffness, tendon adhesion, and immobility. Emergency free flap transfer suggests against these concepts by advocating radical debridement and early closure of these wounds. Early mobilization of the joints with emergency free flap transfer may produce better range of motion than delayed closure. The key to success in early coverage of these wounds is thorough debridement while sparing vital structures, such as nerves, tendons, and intact vessels. We discussed 3 cases, which were performed emergency free flap transfer using lateral arm flap in severe crushing injuries and deep burns of dorsum of the hand. All flaps survived without complications. Each joints had shown 95% range of motion of contralateral normal side on the average. Emergency free flap transfer allows early closure of acute soft tissue defect of dorsum of the hand, promoting early motion and possibly reducing the incidence of post-operative infection, flap failure and secondary operative procedures, and improving functional results.