[Emergency free flap in reconstruction of the lower limb. Thirty-five years of experience].
Authors analyzed 89 cases (86 patients) of lower limb extensive soft tissue defects reconstruction during 1978 to 2013. The mean age is 37 years and 2 months old (range: 5-84 years old). A total of 71 males and 15 female were included. Free flaps were used in emergency in 23 cases for principally covering Gustilo 3B open lower limb fracture and in a later stage for 66 cases all referred from their center for coverage of exposed bone, with frequently osteomyelitis. About the selection of free flaps, in 47 cases we used a latissimus dorsi flaps, 12 cases of epiploon free transfer (in septic area), 10 cases of gracilis transfer and 10 serratus anterior flaps. There are one medial gastrocnemius flap, 2 composite soleus and fibular free flap, 2 antebrachial flap, one inguinal myoosteocutaneous flap, 1 transferred from the other lower limb and one inguinal cutaneous flap. There are 18 free flap losses: one in emergency and 17 after delayed reconstruction. Authors retrospectively analyzed the results (complications, osteomyelitis) according to the timing for lower extremity reconstruction. They found a low infection and flap failure rates (4%) when the coverage is made in the same operating time than initial fracture fixation, they increase to 60% for osteomyelitis and to 23% for flap failure when the reconstruction is delayed.
Service de chirurgie orthopédique, traumatologique, plastique, esthétique et reconstructrice, boulevard Fleming, 25000 Besançon, France. Electronic address: lydiane.bellidenty@laposte.net.
L
L
Bellidenty
Service de chirurgie orthopédique, traumatologique, plastique, esthétique et reconstructrice, boulevard Fleming, 25000 Besançon, France.
R
R
Chastel
Service de chirurgie orthopédique, traumatologique, plastique, esthétique et reconstructrice, boulevard Fleming, 25000 Besançon, France.
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I
Pluvy
Service de chirurgie orthopédique, traumatologique, plastique, esthétique et reconstructrice, boulevard Fleming, 25000 Besançon, France.
J
J
Pauchot
Service de chirurgie orthopédique, traumatologique, plastique, esthétique et reconstructrice, boulevard Fleming, 25000 Besançon, France.
Y
Y
Tropet
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
Fracture ouverte de jambe; Lambeaux libres musculaires; Lower limb soft tissue defect; Lower limb trauma; Muscular free flaps; Open leg fracture; Perte de substance de membre inférieur; Traumatismes de membre inférieur