Microvascular free-flap coverage of mechanical injuries to the upper extremity

Extensive soft-tissue avulsion injuries of the upper extremities with or without bony involvement are difficult reconstructive problems. They usually cannot be adequately managed by traditional methods using skin grafts or local flaps. Microvascular free-tissue transplantation may offer the best chance for success with these severe injuries. Free-tissue transfer is indicated in this type of injury (1) when no simpler method of obtaining a closed wound is available, or (2) when the quality of soft-tissue coverage by simpler methods would not be adequate from a functional standpoint. For example, if a skin graft is placed over bone and tendons, there may be impairment of function, and certainly this is a poor environment for tendon transfers, nerve repairs, and so forth. The much more adequate tissue of a free-flap coverage provides a better environment for reconstruction. Three cases demonstrating these principles have been presented.