Emergency free flaps are performed directly following emergency surgery for coverage of exposed bones and tendons. Four emergency free flaps for finger injuries were performed at our institution between 2012 and 2022. We performed two venous flaps: one using the superficial palmar branch of the radial artery, and another using scavenged tissue for reconstruction of an injured hand. Venous flaps were applied for the reconstruction of the digital artery and soft tissue defects of the palmar region of the finger at the same time, and the superficial palmar branch of radial artery flap and scavenged tissue were applied for the reconstruction of soft tissue defects of the palmar region of the hand and finger. One of the four flaps became completely necrotic; however, no postoperative infections occurred in any of the cases. The reason for the necrosis was due to the lack of adequate outflow in an A-V-A-type venous flap without venous anastomosis. Although the emergency free flap is technically demanding and requires a longer operating time, the procedure may be useful for the reconstruction of soft tissue defects when considering the propensity for vascular fibrosis and vasospasm in delayed operations.
