Arch Hand Microsurg.  2024 Mar;29(1):53-59. 10.12790/ahm.23.0047.

The role of surgical timing in upper extremity free flap reconstruction following trauma: a 10-year single-center, single-surgeon experience

• Park KH
• Woo SJ
• Kang DH

• KMID: 2553172
• DOI: http://doi.org/10.12790/ahm.23.0047

Abstract

Purpose
Complex traumatic upper extremity injuries often require microvascular free tissue transfer for adequate soft tissue coverage or functional reconstruction. The need for rapid coverage is acknowledged, but the optimal timing for reconstruction remains a subject of debate.
Methods
A retrospective review was conducted of patients who underwent free flap reconstruction for upper extremity injuries after trauma from March 2012 to August 2018 in South Korea at a facility specializing in extremity trauma. Surgical timing was categorized according to the classification of Godina into early (within 72 hours after injury) and delayed (from 72 hours to 3 months after injury) reconstruction. Patients’ demographic characteristics, methods of free tissue transfer, flap failure rates, postoperative infections, total hospital stays, and the number of operations required were analyzed.
Results
In total, 80 free tissue transfers were conducted on 76 patients. The demographics and characteristics of patients in the early and delayed reconstruction groups showed no significant differences. Early reconstruction was associated with a significantly lower infection rate, shorter average hospital stay, and a lower average number of operations, without showing a significant difference in the flap failure rate.
Conclusion
The results of this study indicate that early reconstruction within 72 hours after trauma significantly reduces infection rates, the length of hospital stays, and the number of required operations. This study underscores the importance of timely intervention in upper extremity free flap reconstruction for optimal patient outcomes.

Keyword

Complex upper extremity injury; Reconstruction; Trauma; Free flap

Figure

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  Fig. 1. Pie charts showing the percentage and types of free flaps used for early (A) and delayed (B) reconstruction. ALT, anterolateral thigh; PIA, posterior interosseous artery; RASP, radial artery superficial palmar branch; VFG, vascularized fibular graft.

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  Fig. 2. Early reconstruction of right forearm injuries. (A) Preoperative clinical photograph. (B) Immediate postoperative X-ray. (C) Intraoperative clinical photograph after debridement. (D) Immediate postoperative photograph of suprafascial anterolateral thigh free flap reconstruction. (E–G) Six-month postoperative photographs and X-ray.

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  Fig. 3. Early reconstruction of a third-degree burn on hand dorsum. (A) Preoperative clinical photograph of a third-degree burn on the dorsum of the hand. (B) Intraoperative clinical photograph after debridement. (C) Photograph showing the transferred extensor digitorum minimi to the second extensor digitorum communis and extensor indicis proprius. (D) Immediate postoperative photograph of suprafascial anterolateral thigh free flap reconstruction. (E, F) Six-month postoperative photographs.

Reference

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