The Posterior Calf Fascial Free Flap
42
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Walton, Robert L. M.D.; Matory, W. Earle Jr. M.D.; Petry, Judith J. M.D. Author InformationFree flap reconstruction
Cite
Citations (55)
Hand surgery
Reconstructive Surgery
Osteosynthesis
Cite
Citations (3)
The early experience of free flap reconstruction in a regional plastic surgery unit was reviewed. Forty-seven free flap surgical procedures were performed for 46 patients during a 2-year period from 1 January 1995 to 31 December 1996 in a regional plastic surgery centre that specialises in head and neck, and breast reconstruction. Twenty-six free transverse rectus abdominus myocutaneous flaps were performed for 25 breast cancer patients. Head and neck reconstructions were mostly performed after surgical ablation of oral and pharyngeal cancers. A variety of free flaps were used, including fibular osteocutaneous flaps, radial forearm fasciocutaneous flaps, jejunal grafts, and rectus abdominus musculocutaneous flaps. Lateral arm fasciocutaneous and scapular fasciocutaneous flaps were used for three patients who had foot ulceration. The success rate of free flap transfer was 94%. Flap loss was found in three patients who had pedicle complications that were due to traction, kinking, and thrombosis. There was no mortality in the series. The most common morbidity was wound infection. Two thirds of the free flap transfers were uneventful. Seven (15%) patients had major complications that required re-operation. Institutional support was essential for the development of microvascular surgery.
Cite
Citations (4)
Preliminary reports have indicated that debridement of all necrotic soft tissue and bone is a highly efficient method in treatment of lower leg osteitis, if combined with free flap transfer. Yet the question, whether fasciocutaneous or musculocutaneous flaps are the better choice, is controversial. To answer that question, we looked at the files of 69 patients who underwent surgical treatment of osteitis of the leg between 1982 and 1989. Those patients underwent an agressive debridement and closure of the soft tissue defect by free flap transfer in a single stage operation. Long term follow up was possible for 50 patients (72%). Out of these patients two groups were formed: Those being treated treated with musculocutaneous (mc) - and those with fasciocutaneous free flap (fc). In mc-group the 30 patients received 33 flaps, 20 patients of fc 21 flaps. We lost 3 Latissimus dorsi and 2 Parascapular flaps. Flap survival rate was 91% in both groups. The rate of early reexploration was much higher in the mc-group. We could demonstrate, that free flap transfer itself is not the final step in the treatment of osteitis. Only 30% of mc-patients were cured after the transfer. The remaining 21 patients needed another 4.09 (mean) operations. The rate in fc with 65% cured patients was significantly higher. The remaining 7 patients required 3.57 (mean) subsequent operations. Relapse of infection after free flap transfer occurred in 33% (10 pat.) in mc. We found a range of 1 to 6 recurrent fistulas. Five patients have been free of drainage for more than 4 years. Two are still suffering from active infections. Amputation as a final solution in that group had to be done in 3 patients (10%). In the fc-group only 10% (2 pat.) showed a relapse of infection. Both had only 1 fistula. One of these patients has been drainage free for more than 4 years now, one is still active. There were no amputations in that group. So taking the 4 year drainage free time as a measure, mc-group showed an overall success rate of 83%. In fc-group it was much higher with 95%. From our clinical experience we cannot agree with the hypothesis of an antiinflammatory effect of muscle flaps, which has been discussed so often in the literature.
Debridement (dental)
Cite
Citations (17)
A 56-year-old female with a history of meningioma status post subtotal resection (Simpson grade IV) and extensive radiation therapy presented with osteoradionecrosis (O.R.N.) managed previously with a microvascular free flap (MVFF). The evaluation revealed worsening O.R.N. and a scalp defect of 15 × 10 cm. The patient underwent MVFF reconstruction utilizing a free latissimus muscle flap covered by meshed split-thickness skin graft (STSG). Her surgery was complicated by delayed free flap failure and Serratia marcescens growth, which occurred sometime after discharge from the hospital. This was managed with removal of the free muscle flap and skin graft, serial debridement's, antibiotics, and replacements of a synthetic dural matrix and negative pressure wound therapy (NPWT). Once a clean wound bed was again obtained, the patient underwent fasciocutaneous anterolateral thigh (A.L.T.) MVFF reconstruction, which was complicated by left hypoglossal nerve injury, dehiscence of the flap inset, and dehiscence of the neck access incision requiring revision surgery. On the last follow-up 2 weeks after her surgery, the patient had 100% flap viability and a 2 × 1.5 cm on the left parietal aspect of the flap healing be secondary intent. We demonstrate that NPWT is successful in managing open calvarial wounds due to O.R.N.
Negative-pressure wound therapy
Osteoradionecrosis
Debridement (dental)
Wound dehiscence
Cite
Citations (5)
In order to determine the causative factor of microvascular free flap failure and discuss its prevention, we rewiewed 126 patients undergone head and neck reconstruction by the flaps including 67 radial forearm flaps, 26 rectus abdominis myocutaneous flaps, 22 free jejunal flaps, and 11 free colon flaps at Oita Medical University. Out of the total number, 13 flaps (10%) developed a vascular complication and total free flap necrosis occurred in 8 flaps (6.3%). The incidence of diabetes mellitus, hypertension, and previous operation of head and neck was high and they were considered to be risk factors of the free flap f alure. The comlication was due to arterial failure in five flaps and venous congestion in 8 flaps. Cause of the arteial obstruction was thought to be arteriosclerosis which is intrinsic factor of artery itself. Reexploration for the rescue of flaps was attempted, but no flap could be salvaged. The trouble on veins was caused by extrinsic factors that included hematoma and the planning of microvascular anastomosis. Abnormality of the flap was found ralatively early and 5 of 8 flaps could be salvaged. In order to prevent the free flap necrosis, therefore, it was conclued as following. (1) Changing over from a free flap to a vascular pedicled flap should be considered when severe arteriosclerosis is observed during the operation. (2) Avoiding compression of the vein by hematoma and abscess et al, and appropriate planning of microvascular anastomosis are important. (3) The reexploration is initiated as soon as posible in venous congestion.
Cite
Citations (0)
Seroma
Wound dehiscence
Cite
Citations (100)
Shoulder girdle
Wound dehiscence
Free flap reconstruction
Cite
Citations (0)
Introduction Despite the excellent reliability of free tissue transfer, flap failure is devastating, and in addition to patient morbidity, it may increase hospital stay and associated costs. Previous studies have evaluated factors related to flap salvage, regarding the operative strategy for flap salvage surgery. The present study aimed to share our experience of reexploration and describe operative standards dealing with vascular thrombosis. Methods We retrospectively reviewed 150 (of 1258) free flaps for head and neck reconstruction that showed signs of vascular compromise at our institution during a 13-year period between 2002 and 2015. Patient demographics, including sex, age, premorbid health status, personal history, indication for reexploration, flap type, and number of recipient vessels, were analyzed. Days between the end of initial surgery and salvage surgery were also recorded. The incidence of postsalvage complications (hematoma formation, wound dehiscence, and infection requiring surgical intervention) and the overall flap survival were recorded. Results Of the 150 flaps, 87 flaps had evident arterial or venous thrombosis; 34 of these failed and required a second free flap or pedicle flap reconstruction. The remaining 53 were successfully salvaged. Although vascular thrombosis was found to be a major contributing factor in flap loss, no significant differences in any factor were found between patients with salvageable flaps and those with unsalvageable flaps. Conclusions Vascular thrombosis is a major contributing factor in flap loss. The incidence of venous thrombosis is higher, but arterial thrombosis may be more severe. Improvements in the surgical technique and perioperative management are highly reliable. We believe that strict models of flap monitoring; well-trained, dedicated staff; and immediate reexploration will potentially further improve flap survival and optimize the quality of life.
Cite
Citations (61)