EMERGENCY FREE TISSUE TRANSFER FOR SEVERE UPPER EXTREMITY INJURIES

29 patients with severe upper extremity injury were treated with 27 em ergency free flap and three emergency toe-to-hand transfers, after rad ical debridement and primary reconstruction of all injured structures. There was no flap failure, and no infections or wound-healing complic ation were seen. Follow-up ranged from 3 months to 6.6 years with a me an of 3.2 years. 19 patients returned to work (14 to their original jo bs), three were retired and another seven had no employment before inj ury. Operation time ranged from 2 hours 45 minutes to 18 hours 20 minu tes with an average of 7 hours 45 minutes, depending upon the size of the defect and mechanism of injury. Long-term follow-up revealed succe ssful functional and aesthetic results, decreased morbidity and invali dity, and reduced rates of free flap failure, post-operative infection , secondary operative procedures, hospital stay and medical expense.