[Coverage of tissue loss in the upper limb (ten cases)]. / Couverture des pertes de substance du membre supérieur (à propos de 10 cas).

ABSTRACT

PURPOSE OF THE STUDY The purpose of this study was to evaluate early cover of post-traumatic tissue loss in the upper limb. MATERIAL AND METHODS: We report 10 cases of tissue loss in the upper limb treated surgically by fasciocutaneous flaps or muscle flaps. The patients were aged from 14 to 60 years. Six patients underwent surgery as an emergency. Surgery consisted of a thorough debridement, internal fixation if required and soft tissue reconstruction as indicated. This was then followed by immediate flap cover. All had antibiotics during and after surgery. The coverage procedure was selected according to the site and its dimensions. We used 8 fasciocutaneous and 2 muscle flaps in our series. RESULTS: One flap underwent necrosis. The flaps otherwise showed good scaring and trophicity. All the patients were satisfied. DISCUSSION: Early or even immediate coverage of substantial tissue loss following trauma has been made possible because of the development of newer flap techniques. Meyer considers that the improved results can be explained by the fact that early cover prevents bone and tendon desiccation and is achieved before substantial bacterial colonisation can occur. Additionally it is a reliable procedure that brings in vascularised tissue, thereby contributing to reduced scarring of the underlying structures. It also permits immediate osteosynthesis thus avoiding the problems of external fixation. To us the key advantage of emergency skin cover is the fact that the operative field may become colonised but does not become infected. This gives the surgeon the freedom to undertake immediate reconstruction without the prospect of subsequent sepsis.