Microsurgical strategies after free flap failure in soft tissue reconstruction of the lower extremity: a 17-year single-center experience
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 reconstruc...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
22 September 2022
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| In: |
Journal of Personalized Medicine
Year: 2022, Volume: 12, Issue: 10, Pages: 1-16 |
| ISSN: | 2075-4426 |
| DOI: | 10.3390/jpm12101563 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3390/jpm12101563 Verlag, lizenzpflichtig, Volltext: https://www.mdpi.com/2075-4426/12/10/1563 
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| Author Notes: | Felix Struebing, Lingyun Xiong, Amir K. Bigdeli, Yannick Diehm, Ulrich Kneser, Christoph Hirche and Emre Gazyakan |
| Summary: | 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”). |
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| Item Description: | Gesehen am 09.12.2022 |
| Physical Description: | Online Resource |
| ISSN: | 2075-4426 |
| DOI: | 10.3390/jpm12101563 |