Reconstructive Surgery of Soft-Tissue Defects.

Abstract

Traumatic injuries to the extremities that include open fractures and soft-tissue damage are often complicated by severe infection and require multiple reconstructive procedures. Mechanical impact of trauma to soft tissues and the vasculature can result in tissue ischemia and necrosis further increasing the risk of infection. If not treated promptly and aggressively these soft-tissue injuries can spiral out of control and lead to the loss a limb(s) and even the patient’s life. Adequate treatment consists of thorough wound debridement which often results in large tissue defects. Following debridement, optimal treatment consists of reconstruction using local, regional and or distant tissue transfers from suitable donor areas. Optimal outcomes in soft tissue reconstruction are achieved through aggressive excisional debridement of all necrotic and/or infected tissue down to viable wellperfused tissue, careful evaluation of all the involved structures to develop a plan for the best possible restoration of functional and esthetic integrity. During this step, vacuum therapy is often and successfully applied as evaluated in a review by Willy et al. [1]. In complex reconstructions this is best achieved when the surgeon has a large armamentarium of reconstructive techniques to choose from. This issue features three articles in which the authors review the latest techniques and strategies for reconstructing soft-tissue defects of the extremities and abdominal wall caused by trauma and infection. This review discusses a broad array of reconstructive treatments starting at the bottom of the reconstructive ladder with the simplest methods such as primary closure with or without advancement flaps, then onto skin grafts, the use of tissue expanders and muscle and/or faciocutaneous flaps and finally describes the most complex techniques including microvascular transfer of distant tissues (autologous composite flaps and toe to-hand transfers) and tissues taken from brain dead donors (allotransplantation of hand and abdominal wall tissue). The possibility of vascular anastomosis may be judged clinically, by magnetic