New technologies for the management of major extremity wounds.

Soft tissue reconstruction for large or difficult defects, particularly of distal extremities, may be associated with a variety of problems. Crush injuries and infection are often background settings requiring use of considerable resources, time, and skilled personnel for appropriate treatment. Harvested tissue, known as a flap, is used for transferring healthy, viable tissue from one location to the area of tissue loss. Conventional techniques, procedures, and imaging studies used in soft tissue wounds are associated with limitations that often mandate the use of microvascular tissue transfer for lack of a clear alternative. Newer technology, however, may provide an alternative in a significant number of cases. The developments of the perforator flap, digital subtraction angiography, and real-time laser-assisted indocyanine green fluorescent-dye angiography have enabled the use of local tissue for reconstruction heretofore not thought possible. Three cases with distal extremity soft tissue defects were reconstructed using local perforator flaps designed by using these innovative technologies.