IMMEDIATE VERSUS EARLY PRIMARY FREE FLAPS AT THE ZONE OF INJURY IN CASES OF BLUNT TRAUMA TISSUE LOSS

Abstract

Despite that the vast majority of the plastic and reconstructive surgeons approve and recommend the early closure of the traumatic tissue loss (within 72 hours after the injury), preferably by a free muscle flap, the exact timing during this period is still controversial. Some surgeons prefer the immediate reconstruction. After a session of aggressive radical debridement, a free flap is placed to close the wound at the same session; all taking place within 24 hours ofthe injury. The others advise a short session of debridement upon arrival of the patient. 24 to 48 hours after this session, anothu session of debridement takes place followed by closure of the wound, by a free flap, at this same setting. Both rivals noted 100% success rate.

This work has two parts; an experimental and a clinical part. The experimental part aimed at studying the effect of the time lapse since injury in the exactitude of the determination of the arterial zone of injury. This part was realized at the Microsurgery Laboratory, Collage of Surgery, Paris, France. After a pilot study, using four femoral arteries, both femoral arteries of 11 Guinea Pigs were bluntly traumatized, using a hemostat. The hemostat was closed to the end of its lock for 2 minutes, with the artery placed at the third serration of the hemostat. The zone of injury in both arteries was mea-;ured. The right artery was reconstructed at a mean time of 3 hours 35 minutes (group 1). After a mean time of 49 hours 12 minutes, the left artery was measured again and reconstructed (group 2). The clinical part aimed at comparing the immediate ( ""'ithin 24 hours after injury) and the early primary (within 24 and 72 hours after injury) reconstruction by free flaps. The cases were operated upon on the Alexandria University Hospitals (Alexandria, Egypt) and Jean Minjoz University Medical Center (Besan on, France). l.:;imilar to the