Strategy for Reoperative Free Flaps after Failure of a First Flap

Baumeister, Steffen; Follmar, Keith E.; Zenn, Michael R.; Erdmann, Detlev; Levin, L. Scott

doi:10.1097/prs.0b013e3181811ca0

Cited by 45 publications

(48 citation statements)

References 41 publications

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“…The ideal timing for free tissue transfer remains controversial. (12) While some authors claim that the timing of wound management has no effect on flap success rates, others have found otherwise. Khouri and Shaw reported that free flap failure was not time-dependent and the most important factor was the magnitude of the injury sustained.…”

Section: Introductionmentioning

confidence: 99%

Effect of negative-pressure wound therapy on open fractures of the lower limb

Joethy

Sebastin²,

Chong³

et al. 2013

smedj

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Section: Introductionmentioning

confidence: 99%

Effect of negative-pressure wound therapy on open fractures of the lower limb

Joethy

Sebastin²,

Chong³

et al. 2013

smedj

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“…Moreover, the selection of recipient vessel is also very important to avoid flap failure [30]. Although the vessels of the ALT flap match closely to the recipient vessels in head and neck, radical surgery of cancer in head and neck could usually cause the recipient vascular impairment or resection.…”

Section: Discussionmentioning

confidence: 99%

Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck

Jiang

Guo

et al. 2014

PLoS ONE

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The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14–23) cm and the mean width was 4.9 (range: 2.5–7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck.

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“…A recent paper on reoperative free flaps after initial failure of the flap secondary to clotting disorders was published [41]. We have independently published our series of hypercoagulable patients with a complication of 5 total flap losses, two partial losses, and one additional thrombectomy, DVT, and distal limb ischemia [26].…”

Section: Discussionmentioning

confidence: 99%

Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon's inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon's practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.

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Strategy for Reoperative Free Flaps after Failure of a First Flap

Cited by 45 publications

References 41 publications

Effect of negative-pressure wound therapy on open fractures of the lower limb

Effect of negative-pressure wound therapy on open fractures of the lower limb

Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck

Anatomy of Free Flap Failures: Dissection of a Series

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