Factors associated with failure of free gracilis flap in reconstruction of acute traumatic leg defects.

Abstract:

BACKGROUND:Possible factors associated with failure of free gracilis flaps were studied. MATERIALS AND METHODS:All gracilis free flaps used to reconstruct acute traumatic leg defects in a 5 year period were collected. This included open fractures of the tibia and/or fibula in which a gracilis free flap was used for reconstruction. Pre-op factors included age, ethnicity, gender, presence of diabetes, ischaemic heart disease, peripheral vascular disease, or coagulation disorders; days from trauma to flap surgery, Gustilo class, presence of a concurrent ipsilateral femur fracture, and use of CT angiogram to determine adequacy of blood supply. Intra-op factors included type of arterial anastomosis (end to side or end to end), presence of arterial transection, initial arterial anastomotic failure, initial venous anastomotic failure, use of systemic vasoconstrictors by anaesthetists for correction of hypotension, and use of modulators of the coagulation mechanism (dextran/heparin). Post-op factors included post-op day when flap was removed and use of modulators of the coagulation mechanism. RESULTS:Patients with a concurrent ipsilateral femur fracture had a 9.67 (95% CI of OR = 1.32-70.96) times increased risk of flap failure compared to patients without an associated femur fracture. CONCLUSION:The finding of increased risk of free gracilis flap failure for coverage of leg defects in patients with ipsilateral femur fractures has implications on flap selection and pre-operative counselling. In such a situation, a non-microvascular option could be safer if it is available as an alternative.

journal_name

J Plast Surg Hand Surg

authors

Wong JZ,Lahiri A,Sebastin SJ,Chong AK

doi

10.3109/2000656X.2015.1119697

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

125-9

issue

3

eissn

2000-656X

issn

2000-6764

journal_volume

50

pub_type

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