scholarly journals Free Tissue Transfer Optimizes Stump Length and Functionality Following High-Energy Trauma

2019 ◽  
Vol 04 (02) ◽  
pp. e96-e101
Author(s):  
Merisa L. Piper ◽  
Dominic Amara ◽  
Sarosh N. Zafar ◽  
Charles Lee ◽  
Hani Sbitany ◽  
...  
Keyword(s):  
Lower Extremity ◽  
San Francisco ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
High Energy ◽  
Limb Length ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
High Energy Trauma ◽  
Tissue Transfer

Abstract Background Advances in medicine and surgery have allowed patients, who in the past would have required more aggressive amputations, to maintain longer stump lengths. Microvascular free tissue transfer has become increasingly popular to preserve limb length and optimize functionality. We present our experience using microvascular free flap reconstruction to preserve lower extremity limb length in the setting of high-energy trauma. Methods We conducted an Institutional Review Board-approved retrospective review of patients at three San Francisco hospitals who underwent free flap reconstruction after high-energy trauma between 2003 and 2015. We included all patients who underwent free flap reconstruction for lower extremity limb length preservation. We reviewed patient demographics, preoperative variables, intraoperative details, and postoperative outcomes, including complications, functional status, reoperation rates, and need for revision amputation. Results Twelve patients underwent microvascular free tissue transfer for limb length preservation. Overall, the patients had similar preoperative comorbidities and a mean age of 44. Six patients had postoperative complications: three minor complications and three major complications. Seven patients had additional surgeries to improve the contour of the flap. One patient required revision amputation, while the remaining 11 patients preserved their original limb length. The majority of patients were fully ambulatory, and four used a prosthesis. Conclusion Microvascular free tissue transfer can be used to effectively maintain lower extremity stump length following trauma. Although these patients often require multiple surgeries and face lengthy hospital courses, this technique enables preservation of a functional extremity that would otherwise require a more proximal amputation.

S110 – Free Tissue Transfer Reconstruction of Fistula after ACDF

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P114-P114
Author(s):  
Sarah R. Rossmiller ◽  
Tamer Ghanem ◽  
Mark K Wax
Keyword(s):  
Free Flap ◽  
Free Tissue Transfer ◽  
Fistula Formation ◽  
Flap Reconstruction ◽  
Esophageal Diverticulum ◽  
Free Flap Reconstruction ◽  
Incision And Drainage ◽  
Tissue Transfer ◽  
Radial Forearm

Objectives Pharyngeal injury post-anterior cervical disc fusion (ACDF) repair is a well-recognized postoperative complication. It can lead to abscess formation, pharyngocutaneous fistula, and esophageal diverticulum. Various reconstructive procedures have been proposed, including primary repair or pedicled muscle flaps. In recalcitant cases, free tissue transfer can be used. We review our experience with patients undergoing free tissue transfer for repair of pharyngeal defects. Methods Retrospective data review from January 2002 to February 2008 of patients undergoing pharyngeal repair following ACDF surgery. Results 5 patients were identified for total of 6 reconstruction procedures. Presentation of the pharyngeal leak occurred from 8 days to 3 years after the ACDF procedure. 3 patients presented acutely with cervical abscesses requiring incision and drainage. 2 patients underwent hardware removal at the time of incision and drainage. 2 patients presented with dysphagia and a contained esophageal diverticulum. 4 of the patients underwent radial forearm fasciocutaneous free flap reconstruction, and 1 underwent anterolateral thigh musculocutaneous free flap reconstruction. One patient had a revision surgery for recurrent fistula formation after radial forearm free flap with rectus free flap reconstruction. There were no immediate postoperative leaks; however, on 1–51 months follow-up, 4 out of 6 cases developed a diverticulum, with one of them developing a second fistula. 3 out of 5 patients had no evidence of diverticulum or fistula at last follow-up, for a success rate of 60%. Conclusions Pharyngo-esophageal perforation following an ACDF approach is difficult to repair even with free tissue transfer.

scholarly journals Outcome Analysis of End-to-End and End-to-Side Anastomoses in 131 Patients Undergoing Microsurgical Free Flap Reconstruction of the Lower Extremity

2016 ◽  
Vol 02 (01) ◽  
pp. e7-e14
Author(s):  
Sören Könneker ◽  
G.F. Broelsch ◽  
J.W. Kuhbier ◽  
T. Framke ◽  
N. Neubert ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Statistical Significance ◽  
Group Versus ◽  
Outcome Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Survival ◽  
Anastomotic Technique ◽  
End To End

Background End-to-end and end-to-side anastomoses remain the most common techniques in microsurgical free flap reconstruction. Still, there is an ongoing effort to optimize established techniques and develop novel techniques. Numerous comparative studies have investigated flow dynamics and patency rates of microvascular anastomoses and their impact on flap survival. In contrast, few studies have investigated whether the type of anastomosis influences the outcome of microvascular free flap reconstruction of a lower extremity. Patients and Methods Retrospectively, we investigated the outcome of 131 consecutive free flaps for lower extremity reconstruction related to the anastomotic technique. Results No statistical significance between arterial or venous anastomoses were found regarding the anastomotic techniques (p = 0.5470). However, evaluated separately by vessel type, a trend toward statistical significance for anastomotic technique was observed in the arterial (p = 0.0690) and venous (p = 0.1700) vessels. No thromboses were found in arterial end-to-end anastomoses and venous end-to-side anastomoses. More venous (n = 18) than arterial thromboses (n = 9) occurred in primary anastomoses undergoing microsurgical free flap reconstruction (p = 0.0098). Flap survival rate was 97.37% in the end-to-end arterial group versus 86.36% in the end-to-side group. No thromboses were found in five arterial anastomoses using T-patch technique. Conclusion For lower extremities, there is a connate higher risk for venous thrombosis in anastomotic regions compared with arterial thrombosis. We observed divergent rates for thromboses between end-to-end and end-to-side anastomoses.However, if thrombotic events are explained by anastomotic technique and vessel type, the latter carries more importance.

scholarly journals Postoperative care in microvascular free flap reconstruction of the lower extremity: A systematic review

2020 ◽  
Vol 1-2 ◽  
pp. 21-26
Author(s):  
David D. Krijgh ◽  
Milou M.E. van Straeten ◽  
Marc A.M. Mureau ◽  
Antonius J.M. Luijsterburg ◽  
Pascal P.A. Schellekens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Free Flap ◽  
Postoperative Care ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Microvascular Free Flap

Microvascular Free Flap Reconstruction in Pediatric Lower Extremity Trauma: A 10-Year Review

2005 ◽  
Vol 115 (6) ◽  
pp. 1618-1624 ◽  
Author(s):  
Brian Rinker ◽  
Ian L. Valerio ◽  
Daniel H. Stewart ◽  
Lee L. Q. Pu ◽  
Henry C. Vasconez
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Lower Extremity Trauma ◽  
Extremity Trauma ◽  
Microvascular Free Flap

scholarly journals Use of the Anterolateral Thigh in Cranio-Orbitofacial Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
William J. Parkes ◽  
Howard Krein ◽  
Ryan Heffelfinger ◽  
Joseph Curry
Keyword(s):  
Free Flap ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Tissue Loss ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Anterolateral Thigh ◽  
The Many ◽  
Soft Tissue Loss

Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51 free flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications included 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered.

Free-Flap Reconstruction for Diabetic Lower Extremity Limb Salvage

2020 ◽  
Vol 248 ◽  
pp. 165-170
Author(s):  
Z-Hye Lee ◽  
David A. Daar ◽  
John T. Stranix ◽  
Lavinia Anzai ◽  
Jamie P. Levine ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

Lower extremity free flap reconstruction outcomes using venous coupler

Microsurgery ◽  
2011 ◽  
Vol 31 (5) ◽  
pp. 360-364 ◽  
Author(s):  
Ivica Ducic ◽  
Benjamin J. Brown ◽  
Samir S. Rao
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

scholarly journals Reconstructive considerations in head and neck surgical oncology: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S191-S197 ◽  
Author(s):  
M Ragbir ◽  
J S Brown ◽  
H Mehanna
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Pharyngocutaneous Fistula ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Tissue Transfer ◽  
First Choice ◽  
Ablative Surgery

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The reconstructive needs following ablative surgery for head and neck cancer are unique and require close attention to both form and function. The vast experience accrued with microvascular reconstructive surgery has meant a significant expansion in the options available. This paper discusses the options for reconstruction available following ablative surgery for head and neck cancer and offers recommendations for reconstruction in the various settings.Recommendations• Microsurgical free flap reconstruction should be the primary reconstructive option for most defects of the head and neck that need tissue transfer. (R)• Free flaps should be offered as first choice of reconstruction for all patients needing circumferential pharyngoesophageal reconstruction. (R)• Free flap reconstruction should be offered for patients with class III or higher defects of the maxilla. (R)• Composite free tissue transfer should be offered as first choice to all patients needing mandibular reconstruction. (R)• Patients undergoing salvage total laryngectomy should be offered vascularised flap reconstruction to reduce pharyngocutaneous fistula rates. (R)

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