Introduction: The greatest incidence of upper limb crush trauma stimulated imagination of surgeons in surgical strategy elaboration and finding suitable surgical techniques. Microsurgical techniques allowed, when the reconstruction through local and/or regional methods is not suitable, for the free flaps to resolve the problem. The “per primam intentionem” repair importance is outlined for all anatomical lesions. Every time when the local resources are not suitable for reconstruction, microsurgical techniques are used to compensate. Material and methods: Between January 1st 1996 – 31 December 2oo4 in our service there were treated 431 patients with destructive traumas of the upper limb. From these in 84 patients the etiology of traumas were: - crushing for 125 patients, with complete or incomplete amputations in 25 patients. Our strategy involved emergency all in one reconstruction, with extenive debridment of all damaged tissuesand appropiate tissue coverage. This concerned the use of local resources or replacement of the affected tissues with equivalent functional and anatomical tissues using microsurgical methods as: - revasularisation 16 cases, replantation 9 cases; - flow through flaps 4 cases; - free flaps- 44 cases presenting extensive defects, free flaps were used for covering (fasciocutaneous, muscular; fascials, musculocutaneous, osteomuscular digital transfer. In two cases we used 2 simultaneous flaps . The free flaps was used both as surface coverage and functional rehabilitation. Only when the viability of local tissues is uncertain even after extensive debridment we delayed the wound closure for 48-72 hours. Results: - Llocal morphological reconstruction considered acceptable for both patient and surgeon. - functional recovery: varied from 30% (42 cases) to 90% (7 cases) In 109 cases, 1-2 reinterventions were necessary for tenolisis, tenoplasties, artrodeses or other palliative operations. Discussions: Treatments of severed upper limb trauma beneficiate, in our days from microsurgical techniques especially in replantations and free flaps.

Early repair, especially per primam intentionem, of all elements represents the key of a good functional result because prevents the local fibrosis, joint stiffness, muscles denervation and nerve degeneration. For the tissues loss we considered first of all the loco regional resources and when this are over passed, free flaps adapted to the local anatomy and function.