[Timing of free microsurgical tissue transplantation in hand injuries during the acute phase]

Due to favourable survival rates in replantation surgery and a high standard of free tissue transplantation, the interval between injury and microsurgical reconstruction has continuously decreased in the past. The acute phase can be defined as the interval ranging from emergency procedures within 24 hours to "urgence différée" procedures within 72 hours. Bearing in mind the infection rates of 1.5% and 17.5% respectively as it has been reported in the literature, we should encourage emergency reconstructions. However, in most cases of upper extremity injuries, reconstruction with conventional flaps is possible. Between 1981 and 1991, 674 free tissue transplantation have been performed in our unit, 61% of the cases of free tissue transplantations to the upper extremity were done in the acute phase, the majority within 72 hours (urgence différée). No significant differences in rates of infections were evident comparing acute phase and urgence différée procedures. Because of this, we still support the concept of urgence différée. In our opinion the following advantages have to be considered: urgence différée allows a second loop operation, the vitality of the extremity can be ascertained, and the reconstructive procedure can be planned more precisely. Last not least, a procedure performed during the day-time assures better operating conditions. This concept is demonstrated with clinical cases.