Microvascular free tissue transfer for reconstruction of complex lower extremity trauma: Predictors of complications and flap failure

Microsurgery ◽  
2021 ◽  
Author(s):  
Sammy Othman ◽  
John T. Stranix ◽  
William Piwnica‐Worms ◽  
Andrew Bauder ◽  
Saïd C. Azoury ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Tissue Transfer ◽  
Lower Extremity Trauma ◽  
Flap Failure ◽  
Tissue Transfer ◽  
Extremity Trauma

Microvascular reconstruction of pediatric lower extremity trauma using free tissue transfer

2019 ◽  
Vol 29 (2) ◽  
pp. 285-293 ◽  
Author(s):  
L. C. Boyd ◽  
G. A. Bond ◽  
A. Hamidian Jahromi ◽  
S. D. Kozusko ◽  
Zinon Kokkalis ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Tissue Transfer ◽  
Microvascular Reconstruction ◽  
Lower Extremity Trauma ◽  
Tissue Transfer ◽  
Extremity Trauma

Vein Size Mismatch Increases Flap Failure in Lower Extremity Trauma Free Flap Reconstruction

2019 ◽  
Vol 35 (08) ◽  
pp. 587-593 ◽  
Author(s):  
Z-Hye Lee ◽  
Allyson R. Alfonso ◽  
John T. Stranix ◽  
Lavinia Anzai ◽  
David A. Daar ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Thrombus Formation ◽  
Free Flaps ◽  
Theoretical Problem ◽  
Complication Rates ◽  
Size Mismatch ◽  
Lower Extremity Trauma ◽  
Flap Failure ◽  
Extremity Trauma ◽  
End To End

Abstract Background Venous outflow problems are the most common reasons for perioperative flap complications. Size mismatch in venous anastomoses poses a theoretical problem by promoting turbulent flow and subsequent thrombus formation. The purpose of this study was to determine if increased vein size mismatch is predictive of flap failure. Methods Retrospective review of our institutional flap registry from 1979 to 2016 identified 410 free flaps performed for reconstruction of lower extremity trauma. Patient demographics, flap characteristics, and flap outcomes were examined. Venous size mismatch was defined as a difference in size ≥ 1 mm between the recipient vein and flap vein. Results Vein size mismatch ≥ 1mm was present in 17.1% (n = 70) of patients. The majority of anastomoses were end-to-end (n = 379, 92.4%), and end-to-side anastomoses were preferentially used in the presence of vein size mismatch (p < 0.001). Major complications occurred in 119 (29%) flaps, with 35 (8.5%) partial flap losses and 34 (8.3%) total flap losses. Looking specifically at flaps with end-to-end venous anastomoses, venous size mismatch was associated with increased total flap failure (p = 0.031) and takeback for vascular compromise (p = 0.030). Recipient vein size relative to flap vein size (larger or smaller) had no effect on flap outcomes. Multivariable regression analysis controlling for age, sex, flap type, number of veins, recipient vein size, flap vein size, venous coupler use, and vein size mismatch demonstrated that flaps with ≥ 1 mm vein mismatch were predictive of total flap failure (p = 0.045; odds ratio: 2.58). Conclusion Flaps with vein size mismatch ≥ 1 mm demonstrated increased flap complication rates in the setting of end-to-end venous anastomoses. End-to-side anastomosis was preferentially used in vein size mismatch and carried a higher risk of flap failure. Our results support using veins of similar size for anastomosis whenever feasible to protect against flap complications.

Godina's Principles in the Twenty-First Century and the Evolution of Lower Extremity Trauma Reconstruction

2017 ◽  
Vol 34 (08) ◽  
pp. 563-571 ◽  
Author(s):  
David Colen ◽  
Lawrence Colen ◽  
L. Levin ◽  
Stephen Kovach
Keyword(s):  
Lower Extremity ◽  
Wound Care ◽  
Free Tissue Transfer ◽  
First Century ◽  
Soft Tissue Coverage ◽  
Lower Extremity Trauma ◽  
Extremity Trauma ◽  
Reconstructive Microsurgery ◽  
Radical Debridement ◽  
Care Technology

Background February of 2016 marked 30 years since the passing of Marko Godina, a pioneer and prodigy in the field of reconstructive microsurgery. Most noteworthy among his many contributions was his method of radical debridement of contaminated compound fractures followed by early free tissue transfer for wound closure. In the last three decades, the landscape of reconstructive surgery has undergone significant transformation owing to advances in reconstructive techniques and wound care technology, as well as new data. Methods Dr. Godina's work and legacy are reviewed, compared and contrasted with new and evolving data regarding lower extremity trauma reconstruction. Results Advancements in technique and technology have greatly molded lower extremtiy reconstruction over the past thirty years. Nonetheless, Dr. Godina's principles of timely care and early vascularized soft tissue coverage have withstood the test of time. Conclusion Marko Godina's contribution to reconstructive microsurgery cannot be overstated and his groundbreaking work continues to serve as the foundation of lower extremity trauma reconstruction. Three decades after his seminal work, we honor Dr. Godina's legacy and explore how his principles have endured, evolved, or been replaced.

Lower Extremity Free Tissue Transfer in the Setting of Thrombophilia: Analysis of Perioperative Anticoagulation Protocols and Predictors of Flap Failure

2018 ◽  
Vol 35 (04) ◽  
pp. 270-286 ◽  
Author(s):  
Michael DeFazio ◽  
James Economides ◽  
Ersilia Anghel ◽  
Eshetu Tefera ◽  
Karen Evans
Keyword(s):  
High Risk ◽  
Lower Extremity ◽  
Demographic Data ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Heparin Infusion ◽  
Recipient Vessel ◽  
Flap Failure ◽  
Tissue Transfer ◽  
Perioperative Anticoagulation

Background No consensus exists regarding the optimal strategy for perioperative thromboprophylaxis in high-risk microsurgical populations. We present our experience with lower extremity free tissue transfer (FTT) in thrombophilic patients and compare outcomes between non-stratified and risk-stratified anticoagulation protocols. Methods Between January 2013 and December 2017, 57 patients with documented thrombophilia underwent FTT for non-traumatic, lower extremity reconstruction by a single surgeon. Patients were divided into two cohorts based on the introduction of a novel, risk-stratified algorithm for perioperative anticoagulation in July 2015. Demographic data, chemoprophylaxis profiles, flap outcomes, and complications were retrospectively compared across time periods. Results Fifty-seven free flaps were performed in hypercoagulable patients treated with non-stratified (n = 27) or risk-stratified (n = 30) thromboprophylaxis. Patients in the risk-stratified cohort received intravenous heparin more often than non-stratified controls (73 vs. 15%, p < 0.001). Lower rates of total (3 vs. 19%, p = 0.06) and partial (10 vs. 37%, p = 0.025) flap loss were observed among risk-stratified patients, paralleling a significant reduction in the prevalence of postoperative thrombotic events (1.2 vs. 12.3%, p = 0.004). While therapeutic versus low-dose heparin infusion was associated with improved flap survival following intraoperative microvascular compromise (86 vs. 25%, p = 0.04), salvage rates in the setting of postoperative thrombosis remained 0%, regardless of protocol. On multivariate analysis, recipient-vessel calcification (odds ratio [OR]: 16.7, p = 0.02) and anastomotic revision (OR, 3.3; p = 0.04) were independently associated with total flap failure. Conclusion Selective therapeutic anticoagulation may improve microsurgical outcomes in high-risk patients with thrombophilia. Our findings highlight the importance of meticulous technique and recipient-vessel selection as critical determinants of flap success in this population.

MULTIPLE RELAXING SKIN INCISIONS IN ORTHOPEDIC LOWER EXTREMITY TRAUMA

1991 ◽  
Vol 84 (Supplement) ◽  
pp. 60
Author(s):  
Anthony J. DiStasio ◽  
Thomas W. Dugdale ◽  
Martin K. Deafenbaugh
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Trauma ◽  
Extremity Trauma

Common characteristics of functional and adverse outcomes in acute lower-extremity trauma reconstruction

2017 ◽  
Vol 40 (3) ◽  
pp. 235-244 ◽  
Author(s):  
Iris A. Seitz ◽  
Justine C. Lee ◽  
Suela Sulo ◽  
Varun Shah ◽  
Manoj Shah ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Adverse Outcomes ◽  
Lower Extremity Trauma ◽  
Extremity Trauma

scholarly journals “Life is at a standstill” Quality of life after lower extremity trauma in Malawi

2016 ◽  
Vol 26 (4) ◽  
pp. 1027-1035 ◽  
Author(s):  
Racquel E. Kohler ◽  
Jared Tomlinson ◽  
Tiyamike Eletima Chilunjika ◽  
Sven Young ◽  
Mina Hosseinipour ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Extremity ◽  
Lower Extremity Trauma ◽  
Extremity Trauma
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