Covering soft tissue defects

In the past, the main emphasis in the treatment of complex limb injuries was placed upon the reconstruction of bony defects. Recently, however, reconstructive soft-tissue procedures have gained the attention they deserve. The salvage of a severely injured extremity depends rather on the feasibility of reconstructive surgical tissue procedures than on restoration of the bony defect. Sufficient vascularity is an essential condition for fracture healing and the prevention of post-traumatic complications like osteomyelitis and pseudarthrosis. If primary closure of a soft-tissue defect is not possible, preliminary covering has to be obtained with artificial skin replacement (vacuum sealing) until definitive covering with muscle or musculocutaneous flaps can be achieved. With the microvascular restorative techniques available today even complex soft-tissue problems can be solved. Nevertheless, an appropriate infrastructure and a trained and skilled surgeon are essential.