Microsurgical reconstruction is often first-line treatment in trauma cases, yet its role in burn reconstruction remains inconsistent, despite comparable injury complexity and resuscitation demands. While literature suggests mixed outcomes for free flap use in burns, no study has directly compared microsurgical outcomes between trauma and burn reconstructions. This study aimed to evaluate complication rates and outcomes of free flap reconstruction in trauma versus burn patients.

We conducted an institutional review board-approved retrospective cohort study of patients who underwent microsurgical reconstruction following traumatic or burn injuries between October 2016 and September 2024 at a single Level 1 trauma and major burn referral center. Outcomes assessed included flap survival, flap failure, hematoma, infection, flap debridement, and hospital length of stay (LOS). Subgroup analysis compared acute versus delayed reconstructions.

Ninety-six patients met inclusion criteria: 67 in the trauma group and 29 in the burn group. Flap success was 96.6% in the burn group versus 92.5% in the trauma group. Median LOS was significantly longer in burn patients (34 days [interquartile range, IQR: 1–67]) compared with trauma patients (20 days [IQR: 10–30]; p = 0.046). Complication rates did not significantly differ between groups (p = 0.356). In acute cases, flap success was 100% for burns versus 92% for trauma.

Microsurgical reconstruction in burn patients demonstrates similar success and complication rates to trauma patients. Given these comparable outcomes, microsurgeons should actively collaborate with burn teams to ensure optimal care and expand reconstructive options for burn patients.

Received: 24 July 2025

Accepted: 25 February 2026

Accepted Manuscript online:
03 March 2026

Article published online:
19 March 2026

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