Between January 2001 and July 2011, we treated 11 severely injured extremities from 11 patients ( mean age, 58 years; range, 16 to 92 years; 8 men ) with bone and soft tissue reconstruction using vascularized tissue transfers. There were five traffic accidents, four work-related injuries, one farm injury, and one sports injury and two closed and nine open fractures ( 2 IIIA and 7 IIIB ). Reconstruction procedures were latissimus dorsi flap for the forearm in one, radial forearm flap for the foot in one, latissimus dorsi flap and vascularized fibula for the thigh in three, vascularized fibula for the lower leg in five, and vascularized ilium for the lower leg in one. All flaps survived, and bone union was achieved in all patients. All three patients with reconstructed thighs could walk without support. One fistula around a grafted fibula was treated with negative pressure wound therapy. Of six patients with reconstructed lower legs, four could walk without support, but 2 died from unrelated causes. One patient with a reconstructed forearm had moderate range of motion but returned to farming. Vascularized tissue transfers that enable simultaneous reconstruction of composite tissue defects require long operative times and are highly individualized to each patient. Therefore, careful preoperative planning is essential for selecting donor and recipient vessels and for reducing the risk of tissue transfer to obtain maximum functional results.
