Indications for free flaps

Mutilating, high-energy injuries that lead to extensive soft tissue destruction can preclude any possibility of using local pedicled flaps for coverage. Free tissue transfer is warranted when local flaps cannot be harvested outside the zone of injury or when soft tissue defects are extensive and involve exposed vital structures such as bone, tendons, nerves, and vessels. Other major indications for free flap coverage include coverage following extensive scar contracture release due to trauma or burn, and coverage following tumor excision [1,2,8,14,23]. Mutilating hand injuries are particularly amenable to free flap reconstruction because of the ability to transfer multicomponent

Fig. 3. Important surgical anatomy of the lateral arm flap during harvesting. (Courtesy of The Christine M. Kleinert Institute for Hand and Microsurgery, Inc., Louisville, KY; used with permission.)

vascularized tissues such as skin, fascia, bone, tendon, and nerve. Selection of free flap donor sites should be tailored and individualized to meet the recipient site requirements. Chimeric flaps allow composite reconstruction of the mutilated upper extremity by providing well-vascularized skin, muscle, nerve, and tendons. Unlike pedicled groin flaps, free flaps are non-saprophytic and provide well-vascularized tissue with angiogenic and lym-phogenic potential to the wound.

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