PURPOSE:

With improvements in trauma care, outcomes of patients with critical injuries have improved. Severely injured patients are more likely to survive and present with devastating wounds requiring reconstructive procedures. Free tissue transfer is a proven method for treating traumatic injuries; however the role and safety of this technique in patients with concomitant systemic injuries remains unclear.

METHODS:

A retrospective review of all free flaps performed for traumatic injuries between January 1997 and December 2006 by a single surgeon (LSL) was performed. Patient demographics, comorbidities, treatment and outcomes were evaluated. Injury severity scores (ISS) were determined for all patients.

RESULTS:

A total of 170 free flaps were performed on 160 patients during this time period. Seventy-nine patients had injury wounds in the absence of distinct systemic injuries (Group 1). Eighty-one patients had injury wounds in the presence of distinct systemic injuries (Group 2). The mean age and comorbidities were similar in both groups. The ISS was significantly higher in Group 2 (21.5 versus 9.4; p< 0.05)-(Figure 1). A significantly greater proportion of patients in Group 2 sustained injuries secondary to motor vehicle collisions (95.1% versus 20.3%; p< 0.05). The mean time from trauma to flap (tertiary transfer) was 24 days for Group 1 and 16 days for Group 2. Overall flap survival was 92% and total surgical complication rate was 30%, neither of which significantly differed between groups (Figure 2). Length of stay was significantly greater in Group 2 (19.9 days versus 14.1 days; p< 0.05). Subgroup analysis of systemically injured patients (Group 2) demonstrated that ISS was not predictive of flap loss or complications. Furthermore, patients with pulmonary contusion and/or intracranial injury did not portend a worse perioperative outcome.

CONCLUSION:

In this selected group of patients we did not find a significant difference in free flap survival or overall early outcome relative to the presence or absence of systemic injury. This highlights the importance of clinical judgment in determining which patients may be suitable for free tissue transfer. As acute care continues to improve, the complexity and severity of injured patients potentially managed with free tissue transfer will further evolve.