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Limb Salvage in Traumatic Forearm Injuries: Outcomes of Revascularization, Replantation, and Free Tissue Transfer
Muhammad Furqan Haider, MBBS, MS; Muhammad Tariq Iqbal, MBBS, FCPS
Jinnah Burn and Reconstructive Surgery Centre, Lahore, Punjab, Pakistan
Purpose:Severe forearm trauma often necessitates complex limb salvage procedures. This study evaluates the outcomes of immediate free tissue transfer following revascularization or replantation in traumatic forearm injuries, with a focus on limb survival, hand function, and the need for secondary reconstructive procedures.
Methods:A retrospective review was conducted of 10 patients (ages 10-50 years) treated at Jinnah Burn and Reconstructive Surgery Centre, Lahore, Pakistan, between September 2023 and October 2024. Mechanisms of injury included road traffic accidents, industrial machine injuries, and agricultural thresher (toka) trauma. All patients underwent either revascularization (n=6) or replantation (n=4), followed by immediate soft tissue coverage using free flaps. Vein grafts and flow-through flaps were utilized as required. Bone stabilization was achieved via internal fixation, and the median nerve was repaired in all cases. Outcome measures included limb and flap survival, grip strength, and the requirement for secondary procedures such as nerve or tendon reconstruction.
Results:All patients achieved 100% limb and flap survival. Most recovered useful hand function, with average grip strength reaching approximately
60% of the strength in the uninjured hand, which is consistent with outcomes reported in similar cases in the literature. Better functional recovery was observed in patients who had ulnar nerve preservation. Secondary surgeries (e.g., nerve or tendon repair) were required in
4 out of 10 patients (40%). The average hospital stay was 10 days, and there were no major complications during the postoperative period.
Conclusion:Immediate free tissue transfer following revascularization or replantation is a reliable and effective limb salvage strategy for severe forearm injuries. Limb and flap survival rates were excellent, and functional outcomes-particularly hand strength and dexterity-were encouraging, especially with preserved nerve function and early rehabilitation. Secondary procedures were often necessary, emphasizing the importance of a multidisciplinary approach in managing complex upper limb trauma.
Keywords:Limb salvage, forearm trauma, revascularization, replantation, free tissue transfer, microsurgery, hand function, secondary reconstruction.
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