Emergency free flaps to the upper extremity.

Thirty-one emergency free flaps were applied to the upper extremities of patients who ranged in age from 16 to 57 years. The size of the skin defects ranged from 13 to 540 square centimeters, with an average of 145 square centimeters. A variety of flaps were used, including 14 lateral arm, seven groin, five latissimus, three first web space of the foot, one scapular and one medial arm. In patients with small defects, the operative time ranged from 3 to 9 hours, with an average of 4 hours and 54 minutes. The hospital stay was never longer than 4 days. In patients with medium size defects, the operating time ranged from 3 to 18 hours, with an average of 7 hours and 45 minutes. The hospital stay averaged 7.4 days. In large defects in which extensive reconstruction was undertaken before flap application, the operative time ranged from 3 to 20 hours, with an average of 11 hours and 54 minutes. The average hospital stay was 11.8 days. Twenty-nine of the 31 flaps survived in their entirety (93.5%). In one of the successful flaps (3.2%), exploration was required after the patient left the operating room. Severe infection occurred in only one case, that being one of the two flap failures. Twenty-seven of the 31 patients returned to work, 18 of them to their original employment.