Microsurgical strategies after free flap failure in soft tissue reconstruction of the lower extremity

• Verfasst von: Strübing, Felix [VerfasserIn]
• Verfasst von: Xiong, Lingyun [VerfasserIn]
• Verfasst von: Bigdeli, Amir K. [VerfasserIn]
• Verfasst von: Diehm, Yannick [VerfasserIn]
• Verfasst von: Kneser, Ulrich [VerfasserIn]
• Verfasst von: Hirche, Christoph [VerfasserIn]
• Verfasst von: Gazyakan, Emre [VerfasserIn]
• Titel: Microsurgical strategies after free flap failure in soft tissue reconstruction of the lower extremity
• Titelzusatz: a 17-year single-center experience
• Verf.angabe: Felix Struebing, Lingyun Xiong, Amir K. Bigdeli, Yannick Diehm, Ulrich Kneser, Christoph Hirche and Emre Gazyakan
• E-Jahr: 2022
• Jahr: 22 September 2022
• Umfang: 16 S.
• Fussnoten: Gesehen am 09.12.2022
• Titel Quelle: Enthalten in: Journal of Personalized Medicine
• Ort Quelle: Basel : MDPI, 2011
• Jahr Quelle: 2022
• Band/Heft Quelle: 12(2022), 10, Artikel-ID 1563, Seite 1-16
• ISSN Quelle: 2075-4426
• DOI: doi:10.3390/jpm12101563
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: flap failure
• Sach-SW: free flap
• Sach-SW: limb salvage
• Sach-SW: lower extremity
• Sach-SW: orthoplastic
• Sach-SW: secondary free flap
• Sach-SW: tertiary free flap
• K10plus-PPN: 1826706119

Abstract

Background: There is no clear consensus on the optimal surgical strategy for providing safe coverage in salvage free flap surgery after total free flap failure. Methods: A retrospective study was conducted to evaluate patients with total failure of the primary free flap in lower extremity reconstruction between 2000 and 2017. Results: In a cohort of 1.016 patients, we identified 43 cases of total flap failure (4.2%). A total of 30 patients received a salvage free flap with a success rate of 83.3% (25/30). One patient received a secondary salvage free flap. Overall limb salvage after primary free flap loss was 83.7% (36/43). Conclusions: Microsurgical management of free flap loss in the lower extremity is challenging and requires a decisive re-evaluation of risk factors and alternative strategies. This should include reconsidering the flap choice with a tendency towards traditional and safe workhorse flaps, a low-threshold switch to different recipient vessels, including arteriovenous (AV) loops, bypasses (especially in case of venous insufficiency) and back-up procedures, such as negative pressure wound therapy or dermal regeneration templates with skin grafting in cases of lower demand and critically ill patients. We derived one suggestion from our previous practice: replacing perforator flaps with axial pattern flaps (“safe workhorses”).