Post-trauma reconstruction with free tissue transfer--analysis of 442 consecutive cases

We reviewed 442 consecutive free flaps performed between July 1979 and December 1987 in 423 trauma patients. The ages ranged from 2 to 76 years. There were 339 males and 84 females. Soft-tissue coverage was the most frequent (56.3%) indication, followed by unstable wound, extensive bone loss, chronic osteomyelitis, insensate scar, loss of specialized tissue, and contour deformity. Most of the reconstructed defects (72.4%) were located in the lower extremity and the great majority (42.3%) involved the lower third of the leg. Motor vehicle accidents were the main (45.6%) cause of the defects followed by motorcycle injuries (28.6%), industrial accidents (15.1%), farming accidents (3.6%), and gunshot wounds (3.3%). Seventeen types of free vascularized cutaneous, myocutaneous, muscular, osseous, osteocutaneous, fascial, fasciocutaneous, sensate, and specialized tissue transfers were used. The latissimus dorsi free flap was the most frequently performed tissue transfer. Only 2.3% of the flaps were done within the first 48 hours post-trauma, although 76.5% of the transfers were completed within the first 2 weeks after injury. The overall success rate was 96.4% and the incidence of re-exploration was 14.7%. Free tissue transfers provide a very reliable method for dealing with difficult reconstructive problems in trauma patients.