Free tissue transfer to the traumatized upper extremity: Risk factors for XXXX in 282 cases.

@entity1 @entity174 @entity4034 @entity260 @entity281 @entity393
BACKGROUND: Complex traumatic upper extremity injuries frequently possess compromised local vasculature or extensive defects that are not amenable to local flap reconstruction. Free tissue transfer is required to provide adequate soft tissue coverage. The present study aimed to evaluate risk factors that contribute to @entity260 and @entity393 in complex upper extremity reconstruction. METHODS: Retrospective chart review was performed for all @entity1 undergoing free tissue transfer for upper extremity reconstruction from 1976 to 2001. Data collected included @entity1 demographic characteristics, timing of reconstruction, location of @entity174 characteristics, operative interventions, and @entity260 . Statistical analysis was performed using   (2) and Fisher exact tests. RESULTS: In total, 238 @entity1 underwent 285 free tissue transfers and met inclusion criteria, from which 3 were excluded because of inadequate information (n  =  282). Extremities were repaired within 24  h (75 cases; 27%), in days 2-7 (32 cases; 12%), or after day 7 (172 cases; 62%). Timing of reconstruction did not significantly affect postoperative outcomes. Proximal location of injury was significantly associated with superficial (relative risk [RR], 6.5; P  <  .01) and @entity281 (RR, 5.3; P  <  .01), and @entity4034 (RR, 4.0; P  <  .01), although not with flap failure (P  =  .30). Presence of an open @entity174 was significantly associated with developing superficial (RR, 3.1; P  =  .01) and deep (RR, 1.9; P  <  .01) infection, as well as @entity4034 (RR, 1.6; P  <  .01). Having a closed @entity174 did not negatively influence postoperative outcomes. CONCLUSIONS: This study supports the safety of early free tissue transfer for reconstruction of traumatized upper extremities. Injuries proximal to the elbow and open @entity174 were associated with a significantly higher infection rate. Gustilo grade IIIC @entity174 , need for interpositional vein grafts, and anastomotic revision at index operation resulted in significantly higher risk of @entity393 , whereas the presence of @entity174 , @entity174 fixation, and injury location were not predictors of flap failure.
