Microsurgical advances in extremity salvage.

Isolated complex extremity injury requires immediate specialized attention via an interdisciplinary approach. Key steps in surgical management include radical tissue debridement, adequate fracture stabilization, and reconstruction of viable structures—if necessary, by use of autologous blood vessels or nerve grafts. A key step in surgical management and one of the most powerful tools for infection control is an early and radical debridement of devitalized, and potentially contaminated, tissue. Although still considered essential components in reconstructive surgery, local flaps and skin grafting are often associated with an increased rate of wound complications and compromises concerning results, enabling new techniques of free tissue transfer, functional composite free flaps, and preexpanded and chimeric flaps to become better options in extremity salvage surgery.