Emergency free flaps for the reconstruction of open injuries of the upper limb
Currently, debridement of all necrotic and contaminated tissues followed by immediate soft tissue coverage in order to obtain primary healing is the standard approach to all open injuries of the extremities. In 1977, Foucher et al introduced for the first time, the concept of immediate treatment at one time of all injured tissues in complex trauma of the upper limb. A similar approach to injuries of the lower extremity was documented in the works of Byrd et al (1981, 1985) and Godina (1986), who demonstrated the superiority of early closure of complex lesions with free flaps so as to reduce risk of infection and hospital stay and to improve flap survival rate. The final goal of this therapeutic approach called ‘Tout en un temps et mobilisation precoce’ (all-in-one stage and early motion) is early postoperative mobilization of the hand and of the whole upper extremity (Foucher et al 1977). Delay in treatment will lead to higher risk of infection, granulation tissue formation and extended fibrosis, reduced flap survival rate, longer hospital stay, late rehabilitation and eventually poor function.