Objective:
Replantation/revascularization yielded better functional outcomes and subjective satisfactory after amputation or vascular injuries. Free tissue transfer after initial replantation or revascularization was meant to salvage the limb and functional improvement, while the use has yet to be determined. The study was carried out to understand the details of free tissue after replantation or revascularization.
Material and Methods:
Patients who received revascularization or replantation between 2002 and 2020 were retrospectively reviewed. Patients of injury level distal to metacarpophalangeal joint and those without free tissue transfer after initial revascularization or replantation were excluded. Demographic data of the patients, surgery, and injury were recorded. Salvage rate and details of free tissue reconstruction of the upper extremities were collected.
Results:
70 patients who met the criteria were recruited into the study. There were 63 male and 7 female patients. Most of the patients had forearm injuries (35.7%), followed by hand injuries (28.6%). The successful rate was 98%. 70% of the recruited patients received free tissue transfer once, and some even received three times free flap surgeries. The most common procedure was free functioning muscle transfer (n = 39) and followed by soft tissue coverage (n = 36). Functioning muscle transfer was mainly performed in forearm reconstruction, and soft tissue coverage was commonly used for hand injuries.
Conclusions:
Free tissue transfer after replantation or revascularization is critical in upper limb salvage and functional restoration. Major upper extremity injuries required secondary free functioning muscle transfer to deal with the remaining functional deficits and aesthetic outcomes. It is more common to encounter soft tissue deficits in distal injuries. A secondary reconstructive procedure can be predicted based on the level of injury.