The use of axially vascularised flaps in reconstructing dehiscent surgical wounds

Purpose: The purpose of the study is to present the indications and evaluate the effectiveness of axial regional flaps in treating dehiscent surgical traumas. Materials - Methods: During the last three years, 11 patients (7 male, 4 female) underwent a reconstructive operation for a dehiscent surgical wound, which resulted after an orthopaedic, vascular, cardiovascular or urological surgery. Trauma de­hiscence was related to ischemia due to prior radiotherapy, haematoma formation, infection or previous scarring. Prosthetic implants were exposed in five cases. All patients had one to three attempts for primary closure before they were seen by the plastic surgeon. In all cases, a pedicle axial flap was used: a muscle or musculocutaneous flap for managing traumas located over the torso (n = 7), and fasciocutaneous (n = 3) or muscle (n = 1) flaps for those located on the extremities. Results: Follow-up ranged from 2 to 7 months. In all cases, flaps provided safe closure and sufficient coverage of the wound; exposed implants were not removed. No recurrences were recorded. We had a partial necrosis of the skin island in a musculocutaneous pectoralis major flap used for covering a sternal defect; revision consisted in debridement and secondary coverage with a skin graft. Conclusion: Axial flaps offer reliable solutions when we face dehiscent surgical traumas. The appropriate flap is chosen according to the location, size and other characteristics of the defect. Muscle flaps are mostly indicated for reconstructing complicated wounds over the torso, especially in previously irradiated areas, while fasciocutaneous flaps are used for com­plicated traumas of the extremities.