[Free flap for soft tissue loss of the limbs in trauma victims]

We report a series of 67 free flaps performed between 1995 and 2001 for soft tissue loss of the limbs in trauma victims. We searched for elements predictive of failure in order to better identify indications.

The series was predominantly masculine (52 men, 15 women). Mean age was 38.7 years (range 18-63). Thirty-four free flaps were performed on the upper limb and 33 on the lower limb. Trauma was caused by: direct crush with or without bone injury (n=23), burns (n=10), stripping (n=5), complications of open fractures (n=29). The free flaps were performed on day 0 (day of trauma) (n=7), on day 1 or 2 (n=5), from day 3 to 7 (n=12), and from day 8 to 31 (n=43).

There were 19 complications: hematoma (n=2), infection (n=1), vascular problem (n=16), and 7 flaps were lost (10.4%). Logistic regression analysis demonstrated that the type of trauma and vascular complications were determinant factors predictive of failure. Conversely, the limb (upper versus lower), side, gender, age, or time from trauma to flap were not found to influence chances of success.

Our series demonstrated that free flap repair performed in a trauma context for loss of soft tissues of the limbs is a relatively reliable surgical technique since the rate of success is similar to that reported for pediculated flaps. The usefulness of free flaps in the trauma setting is thus demonstrated, but the most appropriate modality remains to be determined. Many authors point out the importance of early cover to limit the risk of complications (osteitis, delayed bone healing). Others have not found this factor to be determinant. In everyday practice, emergency cover is not always possible and the question is whether a flap can be successful if performed late after the initial trauma. Our study demonstrates that the chances of success of a free flap are equivalent when performed early or late after trauma.

Free flaps play an important role in achieving cover of tissue loss of the limbs. The type of trauma appeared to be the only factor predictive of failure.