Long-term outcome after successful lower extremity free flap salvage
<p> <b>Background</b> 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 th...
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| Main Authors: | , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2019
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| In: |
Journal of reconstructive microsurgery
Year: 2019, Volume: 35, Issue: 04, Pages: 263-269 |
| ISSN: | 0743-684X |
| DOI: | 10.1055/s-0038-1675146 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1055/s-0038-1675146 Verlag, Volltext: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1675146 
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| Author Notes: | Amir K. Bigdeli, Emre Gazyakan, Volker J. Schmidt, Christoph Bauer, Günter Germann, Christian A. Radu, Ulrich Kneser, Christoph Hirche |
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| 245 | 1 | 0 | |a Long-term outcome after successful lower extremity free flap salvage |c Amir K. Bigdeli, Emre Gazyakan, Volker J. Schmidt, Christoph Bauer, Günter Germann, Christian A. Radu, Ulrich Kneser, Christoph Hirche |
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| 520 | |a <p> <b>Background</b> 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.</p> <p> <b>Methods</b> 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.</p> <p> <b>Results</b> 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.</p> <p> <b>Conclusion</b> 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.</p> | ||
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