Fourteen consecutive free flaps in 14 days for reconstruction of crush injuries in the 2023 Kahramanmaraş earthquake: A retrospective university hospital experience from the disaster zone.

BACKGROUND: Earthquakes frequently result in high-energy extremity injuries requiring complex soft-tissue reconstruction. Performing microsurgical free-flap procedures in the acute post-disaster setting poses significant challenges due to resource limitations and logistic constraints. METHODS: This retrospective study reviewed patients who underwent free-flap soft-tissue reconstruction in our tertiary university hospital, located within the disaster zone, during the acute phase of the 2023 Kahramanmaraş earthquake (February 06-21, 2023). Of 145 patients hospitalized in our plastic and reconstructive surgery service during this period, 14 underwent free-flap reconstruction and were included. Demographics, flap types, recipient vessels, perioperative details, and outcomes were analyzed. RESULTS: Fourteen consecutive free flaps were performed over 14 days. The mean patient age was 32.8 years (range: 6-60 years); 50% were female. Twelve reconstructions (86%) involved the lower extremity, and two (14%) involved the upper extremity. The anterolateral thigh flap was the most frequently used flap (71.4%), followed by the latissimus dorsi flap (28.6%). In 75% of lower-extremity cases, the anterior tibial vessels of the injured limb were used; cross-leg anastomoses were required in three patients. Flap survival was achieved in 13/14 patients (92.8%). One total flap loss resulted in amputation. CONCLUSION: Early free-flap reconstruction can be successfully integrated into acute trauma care even under disaster conditions when resources are organized efficiently, and surgical teams are coordinated. Our results support incorporating microsurgical capability into disaster-preparedness planning.