Lower limb salvage has advanced since the introduction of the free flap. However, most series of lower extremity reconstructions report failure rates are still higher than for other sites, such as the head & neck and the breast. In order to achieve the higher flap success rate, we retrospectively investigated some controversial points including the timing of the operation, selection of the recipient vessels, and the style of the vascular anastomoses.
Patients and Methods: Twenty-two patients underwent the lower leg reconstruction using 24 free flaps between 1995 and 2003 at the Univ. of Tokyo and Kyorin Univ. Hospitals.
Results: As for the timing of the operation, patients were divided into three groups depending on the period from the trauma to the operation. All three patients who underwent the free flap reconstruction within three days after trauma achieved flap success. Three of nine patients who underwent the free flap after four days and within one month had arterial thrombosis and two of them were failed. Two and four of ten patients who underwent the free flap one month after the trauma had arterial and venous thrombosis respectively, resulting in all flap success except one patient who underwent the second flap transfer. Statistical difference was not seen among three groups. As for the selection of the recipient vessels, there was no significant difference between the anterior tibial and posterior tibial vessels. As for the type of the vascular anastomoses, there was no significant difference between the end-to-end and end-to-side anastomosis style.
Discussion: Although statistical difference was not seen among the groups of the operation timing, the early phase reconstruction (within 3 days after trauma) is preferred because wound infection which may be a major risk of vascular thrombosis can be avoided. As for the selection of the recipient vessels, posterior tibial vessels should be first selected, because the damage to these vessels is less than that to the anterior tibial vessels in many cases. And end-to-side anastomosis should be first selected, because the distal blood flow is secured.
抄録全体を表示