BACKGROUND Despite advances in microsurgical techniques of flap transfer, complex upper extremity trauma reconstruction remains a challenge for surgeons. This study aimed to present the outcomes in using flaps in the subacute reconstruction of complex upper extremity injuries. METHODS From July 2013 to December 2016, 35 patients ranging in age from 23 to 69 years with complicated upper extremity traumatic injuries were treated using flap reconstruction in subacute period. The number and causes of injury were 12 machine crush injuries, 18 machine strangulation injuries, two chainsaw accidents, two traffic accidents, and one incident of heavy bruising. Thirty-five patients underwent flap procedures, including 24 anterolateral thigh flaps (68.57%), five latissimus dorsi flaps (14.29%), and six lateral arm flaps (17.14%). Flap sizes ranged from 3 × 4 to 42 × 16 cm2. The mean time of flap reconstruction was 14 days (range 5-29). During postoperative follow-up, flap appearance, sensory recovery, scarring and satisfaction were assessed. RESULTS The overall flap survival rate was 94.3%.Two flaps developed partial necrosis, both of which were later treated with skin grafting. Traumatic wound infections occurred in three patients. All upper limb injuries were completely covered. The follow-up periods ranged from 18 to 62 months with an average of 2.9 months. All skin flap textures were soft with varying degrees of pigmentation. Flap sensory recovery was S1 in three cases, S2 in eight cases, S3 in 15 cases, and S4 in nine cases. There were no donor site complications other than three cases with scar hyperplasia. CONCLUSIONS The severe upper limb soft tissue defects still achieved satisfactory function and appearance with negligible complications and low amputation rates during the subacute period.

中文翻译：

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使用皮瓣转移的亚急性重建治疗上肢的复杂缺陷。

背景技术尽管皮瓣转移的显微外科技术取得了进步，但是复杂的上肢创伤重建仍然是外科医生的挑战。这项研究旨在介绍在复杂的上肢损伤的亚急性重建中使用皮瓣的结果。方法2013年7月至2016年12月，在亚急性期行皮瓣重建术治疗35例年龄在23〜69岁的复杂性上肢外伤。伤害的数量和原因为：机器挤压伤12例，机器扼杀伤18例，两次电锯事故，两次交通事故和一次重伤事故。35例患者行皮瓣手术，包括24例大腿前外侧皮瓣（68.57％），5例背阔肌皮瓣（14.29％）和6例侧臂皮瓣（17.14％）。襟翼尺寸从3×4到42×16 cm2不等。皮瓣重建的平均时间为14天（范围5-29）。术后随访期间，评估皮瓣外观，感觉恢复，瘢痕形成和满意度。结果皮瓣总生存率为94.3％。两个皮瓣发展为部分坏死，随后均接受植皮治疗。三名患者发生了创伤性伤口感染。所有上肢受伤均被完全覆盖。随访时间为18到62个月，平均2.9个月。所有的皮瓣质地都很柔软，并具有不同程度的色素沉着。皮瓣感觉恢复为S1 3例，S2 8例，S3 15例，S4 9例。除三例瘢痕增生外，没有其他供体部位并发症。