Tube posterior tibial artery flow-through free flap for salvaging upper limbs with contaminated soft tissue defects and arterial injuries

The tube posterior tibial artery flow-through free flap technique is proposed for salvaging upper limbs with severely contaminated or infected soft tissue defects and major arterial injuries. Between January 2016 and February 2024, six patients were treated using this method. This is a two-stage approach involving initial restoration of blood supply via a tube posterior tibial artery flow-through free flap, followed by delayed soft tissue coverage utilizing the unfolded tube flap after a series of wound debridements and vacuum sealing drainage treatments. All upper limbs and flaps completely survived. At the 2-year follow-up, the grip and pinch strength of the injured hands reached 37% (range 29-72%）and 31% (range 12-42%) of the contralateral sides, respectively. The mean Disabilities of the Arm, Shoulder, and Hand score was 60 (range 53-67). This study demonstrates the feasibility and efficacy of the tube posterior tibial artery flow-through free flap technique in complex upper limb salvage cases.<b>Level of evidence:</b> IV.