The amputations of the various segments of the limbs are many times accompanied by complexes defects of the soft tissues, bones or vessels making thus the intervention much more complicate that a simple vascular anastomosis. The microsurgical techniques allowed us to combined various procedure to restore the vascular axes and to repair the defects in the same intervention with a superior functional results.

Material and method

In our experience of 256 cases of replantation/revascularisation in 34 cases we used special techniques: branched vein graft for multiple digital amputation – 8 cases, flow through flaps for extensive cutaneous defects – 20 cases, composite flow through flaps with bone or tendons – 4 cases, regional pedicle flaps simple or composite – 2 cases.

Results

In all this 34 cases the distal segment survived. All the associated free flaps survived and were well integrated. Bone consolidation was faster and we avoid the limb shortening in all cases. There were minor reintervention for tenolysis or flaps readjustment

Conclusion

Using with skill all the possibilities of microsurgery and plastic surgery there are only few cases were a replantation couldn’t be performed. The presence of a well vascularised bone graft in composite flap stimulated a faster consolidation and keeping the normal length of the limb allowed a better and faster rehabilitation. The composite flow through flap is an excellent choice for many complexe trauma solving in the same time mixt vascular tendinous or bone defect.