title: Reusing of the failing free flap "nutrient flap" as salvage procedure.
abstract: A 26-year-old woman sustained a traffic accident injury to her left medial malleolus. A soft-tissue defect 15 × 7 cm with exposure of bone was found and underwent free anterolateral thigh flap to cover it. On the second postoperative day, venous congestion occurred and re-exploration was performed. Re-anastomosis of the vein was done after the thrombectomy; unfortunately, the flap did not recover. We found there was a good granulation bed under the failing flap and thinned the failing flap and used it as a full-thickness skin graft. The graft survived completely; 9 months later, the graft site was softer and of good texture. The patient can wear the same size shoes without a debulking procedure. The free flap provided nutrients to the raw surface and nurtured a good granulation bed while it survived for 50 hours; as a result, it was used as "the nutrient flap." Reuse of the failing free flap as "the nutrient flap" is useful as an alternative backup procedure.
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan; and Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan; and Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Department of Plastic Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan; and Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
authors.forename: Seng-Feng
authors.initials: SF
authors.lastname: Jeng