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Timing of free microsurgical tissue transfer for the acute phase of hand injuries
Abstract:
Because of favourable survival rates in replantation surgery and a high standard of free tissue transfer the interval between injury and microsurgical reconstruction has become gradually shorter. The acute phase can be defined as the interval ranging from emergency procedures within 24 hours to urgent procedures done within 72 hours. Bearing in mind the infection rates that have been reported of 1.5% for the acute phase and 17.5% for the late phase, we should encourage emergency reconstructions. However, in most cases of upper extremity injuries, reconstruction with conventional flaps is possible. Between 1981 and 1995 we did 72 acute post-traumatic free tissue transfers to the upper extremity in our unit within 72 hours (urgently). There were no significant differences in the incidence of infections when acute were compared with urgent procedures. As a result we support the concept of urgent operations. The following advantages are to be considered: urgent operations allow a second look operation, the viability of the extremity can be assessed, and the reconstructive procedure can be planned more precisely. Last but not least, the procedure is done during the day time with better operating conditions.
Insights
Urgent microsurgical reconstruction within 72 hours for upper extremity injuries shows low infection rates, similar to emergency procedures. This supports timely intervention for better outcomes and planning.
Area of Science:
- Microsurgery
- Trauma Surgery
- Orthopedics
Background:
- Microsurgical reconstruction for upper extremity injuries has advanced, enabling shorter intervals between injury and repair.
- The acute phase is defined as procedures within 24 hours (emergency) to 72 hours (urgent).
- Late-phase reconstructions have significantly higher infection rates (17.5%) compared to acute-phase (1.5%).
Purpose of the Study:
- To evaluate the outcomes of acute post-traumatic free tissue transfers to the upper extremity performed within 72 hours.
- To compare infection rates between emergency and urgent microsurgical reconstruction procedures.
- To support the concept of urgent reconstructive operations based on clinical evidence.
Main Methods:
- A retrospective review of 72 acute post-traumatic free tissue transfers to the upper extremity performed within 72 hours between 1981 and 1995.
- Comparison of infection incidence between acute (emergency) and urgent procedures.
- Analysis of advantages associated with urgent operations.
Main Results:
- No significant differences in infection rates were observed between acute and urgent microsurgical reconstruction procedures.
- Urgent operations facilitate second-look procedures, assessment of extremity viability, and precise reconstructive planning.
- Daytime procedures offer improved operating conditions.
Conclusions:
- Urgent microsurgical reconstruction within 72 hours is a viable and safe option for upper extremity trauma.
- The low infection rates support encouraging emergency and urgent reconstructions.
- Timely intervention allows for better surgical planning and patient assessment.