Microsurgical Reconstruction of the Mangled Limb

The mangled extremity that sustains limb-threatening trauma is a challenging condition to manage. Significant tissue defects of the mangled limb result in exposed vital structures such as bone, nerves, vessels, and tendons that require stable, durable coverage in order to receive a reasonable functional outcome. When the extent of soft tissue damage is severe, and serial debridement followed by primary or local soft tissue reconstruction is not appropriate, microsurgical soft tissue reconstruction is indicated for limb salvage. The modern principles of microsurgical soft tissue reconstruction of the mangled limb are described that include the indications, facility requirements, patient assessment, free flap selection, postoperative care, and management of complications. The advantages, disadvantages, and indications of the most commonly used flaps are outlined. The goals of microsurgical reconstruction of the mangled limb are to provide the best wound coverage that allows for early functional rehabilitation while minimizing donor site morbidity.