THE OUTCOMES OF THE FOREARM FLAP APPLICATIONS IN THE UPPER LIMB SEVERE INJURIES RECONSTRUCTION

Abstract

Objective: Improving the outcomes of surgical treatment of upper limb (UL) injuries by using regional soft tissue flaps. Methods: The analysis of surgical interventions outcomes of integumentary tissue defects and forearm and hand structures of traumatic genesis was conducted in 37 patients. Traumatic injuries to the forearm and hand structures with soft tissue defects occurred in 11 patients, and 26 trauma patients were hospitalized. The patients had superficial soft tissue defects (STDs) involving various areas, accompanied by damage to the underlying neurovascular bundles (NVBs), tendons and bones. Results: Depending on the nature of trauma and the injured tissues’ state, the reconstruction sequence’s principle was followed. In 32 (86.5%) cases, the restoration of functional skin integument and reconstruction of injured anatomical structures of the limb were performed in a single stage. Twostage reconstruction was carried out in 5 (13.5%) patients, with initial STDs repair followed by reconstruction of the NVBs and tendons. Selection criteria for a sequence of surgical repair included the nature of the injury and the severity of the patient’s condition in emergencies. The following grafts were used: RFFF: radial forearm free flap (n=3); RRF: the reverse radial forearm flap (n=25); the ulnar reverse forearm flap (n=6), PIA: posterior interosseous artery flap (n=3). In the immediate postoperative period, compromised blood circulation in the transplanted flaps were observed in 2 (5.4%) cases. Timely diagnosis and treatment resulted in a positive outcome. Long-term functional and aesthetic outcomes of the reconstruction were considered acceptable in all patients. Conclusion: A proper surgical procedure selection for UL structures injuries and their consequences influences long term postoperative aesthetic and functional outcomes. Choice of single or multiple stages of reconstruction largely depends on the location of the defect, the state of the tissues in the recipient area and the nature of the injury to the underlying anatomical structures of the limb. Keywords: Upper limb, injuries and their consequences, soft-tissue defect, flaps.