title: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a Department of Hand & Reconstructive Microsurgery , National University Hospital , Singapore and.
authors.forename: Joel Z H
authors.initials: JZ
authors.lastname: Wong
authors.affiliation: a Department of Hand & Reconstructive Microsurgery , National University Hospital , Singapore and.|b Department of Orthopaedic Surgery , Yong Loo Lin School of Medicine, National University of Singapore , Singapore.
authors.forename: Amitabha
authors.initials: A
authors.lastname: Lahiri
authors.affiliation: a Department of Hand & Reconstructive Microsurgery , National University Hospital , Singapore and.
authors.forename: Sandeep Jacob
authors.initials: SJ
authors.lastname: Sebastin
authors.affiliation: a Department of Hand & Reconstructive Microsurgery , National University Hospital , Singapore and.|b Department of Orthopaedic Surgery , Yong Loo Lin School of Medicine, National University of Singapore , Singapore.
authors.forename: Alphonsus K S
authors.initials: AK
authors.lastname: Chong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005360:Fibula / Q000293:injuries / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery; D058752:Free Tissue Flaps / Q000009:adverse effects*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D064827:Myocutaneous Flap; D012189:Retrospective Studies; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery; D055815:Young Adult
keywords: complications; free flaps; microsurgery; open fracture