Lower Extremity Salvage Using a Free Flap Associated With the Ilizarov Method in Patients With Massive Combat Injuries

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.

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Long-Term Outcome after Successful Lower Extremity Free Flap Salvage

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1675146 ◽

2018 ◽

Vol 35 (04) ◽

pp. 263-269 ◽

Cited By ~ 5

Author(s):

Amir Bigdeli ◽

Emre Gazyakan ◽

Volker Schmidt ◽

Christoph Bauer ◽

Günter Germann ◽

...

Keyword(s):

Lower Extremity ◽

Free Flap ◽

Free Flaps ◽

Term Outcome ◽

Long Term Outcome ◽

Component Score ◽

Sf 36 ◽

The Mean

Background Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge. It necessitates urgent re-exploration, but the logistic challenge to provide sufficient resources for the emergency intervention remains. The aim of this study was to analyze the long-term outcome after successful lower extremity free flap salvage. Methods A single-center retrospective study including long-term follow-up was approved by the local ethics committee. From January 1999 to December 2010, a total of 581 free flaps were performed for lower extremity reconstruction. Eighty-six flaps required emergency re-exploration, of which 65 could be salvaged. Fifteen salvaged flaps were excluded from the study because of secondary amputation. Of 50 patients, 29 (6 females and 23 males) were eligible for follow-up. The mean follow-up time was 54.5 ± 32.9 months. Health-related quality of life (Short Form 36 [SF-36]) and scar quality (Vancouver Scar Scale [VSS]) were analyzed. Results The overall flap survival rate was 94.7% and the total loss rate was 5.3%. The re-exploration rate was 14.8% (86 of 581 flaps). The salvage rate was 75.6% (65 of 86 flaps). Twenty-one free flaps were totally lost (24.4%). Partial flap loss occurred in 12 cases (14.0%); 67.5% of the vascular complications occurred during the first 24 hours, 20.9% between 24 and 72 hours, and 11.6% after more than 72 hours. The mean time from the first signs of impaired flap perfusion to re-exploration was 1.3 ± 0.4 hours, and from free tissue transfer to re-exploration was 16.2 ± 1.9 hours. The overall scar appearance was good with an average VSS score of 4.0 points. The average SF-36 physical component score was 54.4 ± 5.4 and the mental component score was 63.1 ± 10.7. Conclusion Careful monitoring and the opportunity for urgent re-exploration are the key to success for free flaps salvage. Following these principles, an acceptable long-term outcome can be achieved.

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Should Antiplatelet Therapy Be Withheld Perioperatively? The First Study Examining Outcomes in Patients Receiving Dual Antiplatelet Therapy in the Lower Extremity Free Flap Population

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000008666 ◽

2021 ◽

Vol 149 (1) ◽

pp. 95e-103e

Author(s):

Mark D. Mishu ◽

Elizabeth G. Zolper ◽

Paige K. Dekker ◽

Christopher M. Fleury ◽

Jenna C. Bekeny ◽

...

Keyword(s):

Lower Extremity ◽

Antiplatelet Therapy ◽

Free Flap ◽

Dual Antiplatelet Therapy

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Clinical application of the anterolateral thigh free flap in high energy injuries of the lower extremity

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211374 ◽

2021 ◽

Vol 9 (4) ◽

pp. 1192

Author(s):

Del Carmen-Ortega Ignacio ◽

Cahuana-Quispe Alberto Ignacio ◽

Jaimes-Duran Edwing Michel ◽

Soulé-Martínez Christian Enrique

Keyword(s):

Lower Extremity ◽

Free Flap ◽

Donor Site ◽

High Energy ◽

Road Accident ◽

Anterior Tibial Artery ◽

Osteosynthesis Material ◽

Anterior Tibial ◽

End To End ◽

The Right

One of the recurring problems in plastic and reconstructive surgery is the loss of tissues of the lower extremities as a result of high-energy injuries. The difficulty of this reconstruction lies in the need for a sufficiently suitable and resistant tissue to allow this restoration. The thigh-free anterolateral flap, since its description in 1984, has great versatility for complex or extensive lower extremity reconstructions. We presented the case of a 37-year-old male patient who had a high-energy road accident on a bicycle, impacting a moving vehicle causing a multi fragmented fracture of the right proximal tibia AO 41 C2.2/Schatzker V. He was treated surgically with material from osteosynthesis and iliac crest graft. It is complicated by infection of the surgical wound, exposure of osteosynthesis material and absence of skin covering. Reconstruction of the upper third of the right leg was performed with a thigh-free anterolateral free flap with 2 end-to-end venous anastomoses from the flap to anterior tibial veins, and 1 end-to-end anastomosis from perforating artery to anterior tibial artery, with no associated complications. The thigh-free anterolateral free flap is a versatile and reliable mechanism for the reconstructive surgeon, as it provides excellent coverage for complex lower extremity wounds as well as low donor site morbidity. Outpatient follow-up with adequate clinical evolution was done.

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