Emergency free tissue transfer for reconstruction of acute upper extremity wounds

The accepted method of treatment for acute, contaminated, upper extremity wounds is serial débridement and delayed closure. Emergency free tissue transfer challenges these concepts by advocating radical débridement and early closure of these wounds. The use of emergency free tissue transfer in the upper extremity allows early motion and possibly lowers the rates of infection, nonunion, flap failure, and the length of hospital stay. The decision to carry out emergency free tissue transfer is made after evaluating the patient's systemic condition and the following factors: (1) extent of débridement, (2) bacterial load, (3) fracture type, (4) anatomical location of the wound, and (5) presence of exposed vital structures. When conditions are ideal, emergency free tissue transfer may be the best choice for closure of acute, contaminated, upper extremity wounds.