Timing of soft tissue reconstruction in severe crush inury of the upper extremity

Complex injuries of the distal forearm and the hand by industrial machines often require extensive reconstructive procedures. Crush injuries with soft tissue damage extending over the limits of visible injury require a specia l approach. Large soft tissue defects often have to be covered by extensive flap procedures. The optimum point of time for plastic reconstruction is a n essential question and represents a controversial issue in the literature . To be able to compare different patient cohorts in the future., we classi fy crush injuries into five clinically relevant categories. In the course o f this review article, three different cases of severe crush injuries of th e upper extremity are representatively discussed. Two patients were reconst ructed in a secondary procedure, one patient in the acute phase. Definite c overage of soft tissue defects in severe crush injuries should be performed secondarily after 5-7 days since the extent of damage in this special form of trauma can often only be judged after a few days and the reconstruction of bones, vessels and tendons is completed.