Re‐evaluating the paradigm of early free flap coverage in lower extremity trauma

Re‐evaluating the paradigm of early free flap coverage in lower extremity trauma Early free flap coverage in lower extremity trauma is a practice largely supported by research that may be outdated and is frequently impractical due to logistics, resuscitation efforts, and associated injuries. Our objective was to re‐evaluate this paradigm to determine whether reconstructive timing impacts outcome in modern clinical practice. We reviewed 60 free flaps for traumatic lower extremity coverage from December 2005 to December 2010 by the plastic surgery service at an academic medical center. All reconstructions were >72‐hours from injury, spanning from 3 days to 2.2 years. The overall failure rate was 13.3% (8/60). Statistical analysis yielded no significant associations between reconstructive timing and flap failure or morbidity, although there was a trend toward fewer failures among latest reconstructions (>91 days) compared to within 30 days (P = 0.053). These findings support that delays may be safely utilized to allow patient and wound optimization without negatively impacting outcomes in free tissue transfer. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Microsurgery Wiley

Re‐evaluating the paradigm of early free flap coverage in lower extremity trauma

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Publisher
Wiley
Copyright
"Copyright © 2013 Wiley Subscription Services, Inc., A Wiley Company"
ISSN
0738-1085
eISSN
1098-2752
DOI
10.1002/micr.21994
pmid
22730189
Publisher site
See Article on Publisher Site

Abstract

Early free flap coverage in lower extremity trauma is a practice largely supported by research that may be outdated and is frequently impractical due to logistics, resuscitation efforts, and associated injuries. Our objective was to re‐evaluate this paradigm to determine whether reconstructive timing impacts outcome in modern clinical practice. We reviewed 60 free flaps for traumatic lower extremity coverage from December 2005 to December 2010 by the plastic surgery service at an academic medical center. All reconstructions were >72‐hours from injury, spanning from 3 days to 2.2 years. The overall failure rate was 13.3% (8/60). Statistical analysis yielded no significant associations between reconstructive timing and flap failure or morbidity, although there was a trend toward fewer failures among latest reconstructions (>91 days) compared to within 30 days (P = 0.053). These findings support that delays may be safely utilized to allow patient and wound optimization without negatively impacting outcomes in free tissue transfer. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.

Journal

MicrosurgeryWiley

Published: Jan 1, 2013

References

  • On the timing of soft‐tissue reconstruction for open fractures of the lower leg
    Hertel, R; Lambert, S; Muller, S; Ballmer, F; Ganz, R
  • The timing of microsurgical reconstruction in lower extremity trauma
    Karanas, YL; Nigriny, J; Chang, J

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