抄録
The management of a severe open fracture of an extremity requires early soft tissue coverage with a well-vascularized free flap after radical debridement and bone fixation.
A total of 76 patients (57 male, 19 female) ranging from 10 to 81 years of age, underwent free flap transfer due to a traumatic injury to an extremity between January 1995 and June 2010. Seventy-one of the 76 flaps survived, one showed total necrosis and four showed tip necrosis. The rate of flap failure was 1.3%. The authors prefer to use an anterolateral thigh flap, which provides thin and pliable skin and long large-caliber pedicle. In delayed reconstruction, microvascular anastomoses should be performed apart from the defect, since fibrosis after edema and inflammation is present along the intermuscular space surrounding the recipient vessels and reaching an area far away from the defect. When little bleeding results from the recipient artery in the area where it is not contused, this is misjudged as a spasm; however it is improved or resolved after cutting perivascular sheath or periarterial fibrosis. The authors combined the triangular portion of the flap to avoid compression to the recipient vessels and to also allow for microvascular anastomoses proximal to the area of injury.
