title: Risk factors and therapeutic strategy after failure of free flap coverage for lower-limb defects.
abstract: From 2004 to 2007, 148 limb free flaps were performed in a series of 138 patients at the University Hospital in Nantes, France. Flaps were successful in 127 instances (rate: 86%; group A) and failed in 21 (group B). An analysis of the various factors (pre-, intra-, and postoperative) in both groups that may have influenced the outcome of surgery identified the following: operating time, cold ischemia time, and the interval before reoperation. This report is based on our experience in managing 21 free flap failures during reconstructive surgery of the limbs. The causes of failure were analyzed, and possible therapeutic strategies defined (i.e., a second free flap procedure, a pedicle flap, coverage with artificial dermis, or amputation). In our opinion, careful analysis of the causes of flap failure is essential to an appropriate choice of subsequent therapeutic strategy.
authors.affiliation: Service de chirurgie plastique et reconstructrice-Centre des brûlés, Hôpital Jean Monnet, CHU de Nantes, France. pierre.perrot@chu-nantes.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Perrot
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Bouffaut
authors.forename: Christophe
authors.initials: C
authors.lastname: Perret
authors.forename: Jérôme
authors.initials: J
authors.lastname: Connault
authors.forename: Franck
authors.initials: F
authors.lastname: Duteille
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000009:adverse effects* / Q000098:blood supply; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult