Importance of primary repair of complex hand injuries with free flaps

Background: The treatment of large and complex hand injuries is particularl y challenching concerning the functional and cosmetic outcome. In this kind of injuries the primary defect cover is of paramount importance and so the initial situation for secondary reconstructive options may be evidently im proved. Material & methods: Between October 1986 and Mai 1996 43 patients with larg e complex and combined hand injuries were primarily treated with 49 free fl aps. The mean followup was 39 (6 to 92) months, the mean hospital stay was 19(8 to 40) days. Depending on the time of the reconstruction and based on a classification established in our clinic, the patients were distributed a mong th ree groups: primarily (within 24 hours), delayed (between 2 and 7 d ays), and late (after 7 days till 3 weeks posttraumatically) reconstruction . Results: Within the group of primary reconstruction the best results could be achieved, since radical debridement and primary defect cover by healthy tissue (free flap) led to physiological wound healing. That caused reduced hospital stay thus decreased costs, since flap failure, infection and multi ple secondary surgical interventions could be diminished. Also earlier reha bilitation and reintegration into social life and profession was achievable . Conclusion: Due to the obtained results a primary treatment of large and co mplex hand injuries through radical debridement and reconstruction with fre e flaps seems to be effective and should already be considered in the emerg ency room.