Reconstruction techniques for upper extremity crush injuries with massive tissue loss and open fractures: a prospective study.

Objective: Crush injuries and open fractures are often accompanied by extensive tissue loss, rendering clinical and surgical management quite challenging, particularly in the upper extremities. The primary goal in these cases is to obtain a functional and cosmetically acceptable limb. However, the management of complex crush injuries (involving extensive tissue loss and open fractures) is associated with a variety of complications, ranging from infection to amputation. In this study, we aimed to analyze the clinical outcomes of reconstruction for managing complex upper extremity crush injuries.

Patients and methods: We reviewed the clinical and surgical data of patients with complex upper extremity crush injuries who were treated at five Level III trauma centers between July 2012 and December 2022. Patients with an injury that could not be replanted at the time of trauma, those who succumbed to the injuries before reconstruction, and patients with a postoperative follow-up time of < 1-year, missing data, or lost to follow-up were excluded. Data regarding demographic characteristics, clinical examination, radiological images, mechanism of injury, orthopedic or non-orthopedic injuries, comorbidities, tissue loss size, surgical procedures, number of debridement and first debridement time, complications, number of days of hospitalization and, if any, intensive care unit stay, were recorded.

Results: Twenty-one patients were included in the study (mean age = 37.4 ± 7.25; range = 16-62 years; 17 males, 4 females). Road traffic accidents were the most frequently documented cause of injury. The mean time to the first reconstruction was 4.2 ± 1.2 days. Tissue defect sizes ranged from 6 × 4 cm to 18 × 12 cm. Anterolateral thigh flaps, latissimus dorsi flaps, radial forearm, and lateral arm flaps, with sizes ranging from 3 × 6 cm to 18 × 26 cm, were used in the patients.

Conclusions: Simple reconstruction techniques, such as skin grafts or island flaps, can provide satisfactory results in terms of both appearance and function in upper extremity crush injuries with significant bone exposure and large soft tissue defects.