Influence of Recipient Vessels on Free Tissue Transplantation of the Extremities

Abstract

A retrospective analysis of the records of 107 free flap transplants in 94 patients operated on between May of 1992 and September of 1997 at the Center for Microsurgery of Extremities, Nopparatrajathanee Hospital, was conducted to study the risk factors leading to free flap failure. These factors were periods of operation to reflect the experience of the surgeon, locations of the defects, anastomotic techniques, and the use of vein grafts. Chi-square, Fisher's exact test, and multiple logistic regression analysis were used to determine the significance of the data. The overall vascular complication rate was 28 percent (30 of 107 transplants) and the re-exploration rate was 13 percent (14 of 107 transplants), the flap salvage rate was 50 percent (7 of 14 flaps), whereas the overall failure rate was 15 percent (16 of 107 transplants). The significant factors that caused free flap failure were the experience of the surgeon and the use of vein grafts. The most important experience was in the choice and preparation of the recipient vessel. When the surgeon gained more experience in the past 2 years (from October of 1995 to September of 1997), the success rate improved significantly. Moreover, the use of vein grafts no longer affected the outcome. Therefore, in this investigation the most important factor that improved the outcome of free tissue transplantation in the extremities was the experience of the surgeon in choosing and preparing the recipient vessels.

Salvage of compromised free flaps in trauma cases with combined modalities

“…According to Khouri, intraoperative revision of anastomosis did not increase the failure rate. A good choice of recipient vessel is of great importance for the outcome 11. When revising the failed free flaps, Hidalgo and Jones13 found that lysing the adventitia helped in improving the flow.…”

“…In high‐voltage electrical injuries, the electric entry wounds are usually located on the distal extremity. The zone of injury can be extensive and sometimes hard to identify clinically 11. According to Shen et al, inspection of the recipient vessels under the operating microscope is a reliable indicator of patency and functionality 17.…”

Reconstruction of the plantar toe with a distal reverse instep sensory island flap

“…A distant flap can be bulky and unreliable (Akhtar et al, ). Free flaps are effective but carry a risk of thrombosis and require an experienced surgeon (Chaivanichsiri, ; Cho, Garcia, & Pien, ). Reverse dorsalis pedis flap texture and thickness are not the same as the plantar surface, so this flap is not suitable for coverage of the plantar surface of the great toe and the distal head of the first metatarsus (Ishikawa et al, ).…”

Salvage of a Free Flap Using Postoperative Percutaneous Angioplasty in Patients with Diabetic Foot Ulcers

“…Free flap surgery should be performed in PAD patients after establishing blood flow preoperatively by using percutaneous transluminal angioplasty (PTA) or bypass surgery [1,2]. However, even after successful revascularization, intraoperative spasm or thrombosis of the recipient artery can occur, and unless resolved before anastomosis, it may lead to flap failures [3]. Herein, we report 2 cases of prolonged recipient arterial compromises that occurred abruptly after donor flap harvest.…”

“…When choosing and preparing recipient arteries, spasm and thrombosis are major contributing factors in free flap loss [3]. Spasms can be managed with warm solutions, spasmolytic agents, lidocaine, adventitial stripping or Fogarty catheter, and thrombosis can be managed with manual milking, irrigation with heparinized solution, or reanastomosis [4].…”