Restoring Form and Function After Severe Limb Trauma: Contemporary Strategies for Complex Extremity Reconstruction

Résumé fourni par la source

Complex post-traumatic injuries of the extremities remain a major reconstructive challenge because they may simultaneously involve skin, soft tissues, muscle, tendons, nerves, blood vessels, joints, and bone. The objective of this study was to analyze the principal reconstructive strategies used in severe extremity trauma and to determine their relationship with limb preservation, functional recovery, complication reduction, donor-site morbidity, and aesthetic integration. An integrative literature review with a comparative analytical approach was conducted according to the principles of the Scientific Method. Evidence concerning reconstructive timing, orthoplastic management, muscle and fasciocutaneous flaps, free-tissue transfer, limb salvage, functional outcomes, rehabilitation, and aesthetic results was identified and comparatively analyzed. The findings showed that early definitive soft-tissue coverage was associated with lower rates of flap failure and infection, although contemporary evidence supports an individualized therapeutic window according to wound condition and patient stability. Muscle and fasciocutaneous free flaps demonstrated broadly comparable outcomes for infection, revision surgery, and limb salvage, while fasciocutaneous flaps showed advantages in selected outcomes related to donor-site morbidity and flap loss. Overall flap survival and limb-salvage rates were high, frequently exceeding 90%; however, functional recovery was less uniform, demonstrating that technical success does not necessarily correspond to complete restoration of pre-injury function. Aesthetic satisfaction, contour, tissue thickness, scar characteristics, donor-site effects, and social reintegration also emerged as relevant components of long-term outcome. The evidence supports an early, individualized, defect-oriented, multidisciplinary, and patient-centered orthoplastic approach. Contemporary extremity reconstruction should therefore be evaluated according to its capacity to restore a viable, stable, durable, functional, and aesthetically integrated limb rather than by flap survival alone.

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