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

ABSTRACT

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.