Long-term follow-up of patients undergoing free tissue
transfer to the lower limb following trauma
David J. Bruce
Mark J. Ponsford
Timothy E. Goodacre
Received: 19 January 2013 / Accepted: 11 March 2013 / Published online: 6 April 2013
Springer-Verlag Berlin Heidelberg 2013
Background Free flap transfer reconstruction following se-
vere lower limb trauma has become an increasingly used tool
over the past four decades. However, little is known about the
long-term outcome of these complex and costly procedures.
The aim of this work is to assess the long-term outcomes in
patients undergoing free flap transfer reconstruction of
Gustillo IIIB lower limb injuries at the John Radcliffe Hospi-
tal, Oxford (UK).
Methods Forty-two potential participants were identified and
contacted after review of operation records between 1990 and
2000. Physical and psychosocial outcomes were assessed
using SIP, WOMAC and study-specific questionnaires.
Results Eighteen participants responded, with a median
follow-up time of 14 years since reconstruction. Road traffic
collisions were the most common cause of trauma (12/18).
The majority of participants (13/18) had SIP physical and
psychosocial sub-scores equivalent to the general popula-
tion (<5), and half the participants reported normal function
in the study specific questionnaire (9/18). Two participants
reported SIP physical sub-scores of ≥20, implying severe
physical disability, associated with higher pain and stiffness
scores in the WOMAC and study-specific questionnaire.
Conclusions The participants considered in this cohort gen-
erally have excellent long-term outcomes, in terms of func-
tion, aesthetic appearance and psychosocial well-being. The
cohort presented here sets a standard by which other long-
term studies can be measured.
Level of Evidence: Level IV; therapeutic study.
High-energy open fractures to the lower limb are devastat-
ing injuries with significant sequelae in terms of patient
physical and psychological well-being. Technical advances
over the last 40 years have seen the refinement of free tissue
transfer techniques and their implementation in place of
amputation . However, little has been reported of the
long-term functional outcome following these costly and
complex limb salvage procedures.
Free tissue transfers are flaps of undamaged muscle
and/or skin harvested from a distant site and transported
with their vasculature to damaged areas, with subse-
quent revascularisation using microsurgical techniques.
The advantage they bring compared with the use of
grafted tissue reflects their independence from the re-
cipient site circulation and the ability to transfer multi-
ple tissue components (composite tissues). This is
particularly important for the management of severe
D. Gill (*)
D. J. Bruce
M. J. Ponsford
T. E. Goodacre
Plastic Surgery Department, John Radcliffe Hospital,
Headley Way, Headington,
Oxford OX3 9DU, UK
Eur J Plast Surg (2013) 36:431–442