Most extremity trauma results in severe soft tissue injury.  When the decision is made to reconstruct a mangled extremity, options for soft tissue reconstruction and timing of the reconstruction is considered. 

The soft tissue has a large supply of blood so when there is injury to it the blood flow to the injured area is decreased, resulting in less ability to heal the fractures and soft tissue. In severe extremity trauma the injured soft tissue must be removed (debrided), resulting in a larger deficit and an area that must be reconstructed. 

It has been shown that early coverage is an advantage to healing the area, and minimizing chance for infection. The timing of coverage is discussed by the physician team to assure that fractures are adequately stabilized and the injured area is free of infection.  The goal is to cover the area as soon as possible to assist in healing.

Free tissue transfers, and muscle flaps are utilized to reconstruct soft tissue injury.  The decision regarding type of reconstruction depends on the area of the injury and soft tissue available. 

Tissue commonly utilized for free tissue transfers includes the latissimus dorsi muscle (from the back), the rectus abdominus muscle (from the stomach), and the serratus anterior muscle (from the back and side of the trunk). The ability to take muscle from one part of the body to reconstruct the injured area provides the treating team options to amputation of severely injured limbs.

Tissue commonly utilized for local muscle flaps includes the medial gastrocnemius (calf muscle), the gracilis (muscle on the inner thigh), and the muscles of the forearm (radial forearm flap).

Click here to see examples of these flaps.