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Reconstruction of difficult wounds with tissue-expanded free flaps
T Oguz Acarturk1, Donald P Glaser, E Douglas Newton
1Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA. acarturko@upmc.edu
Annals of Plastic Surgery
|April 21, 2004
Summary
Pre-transfer tissue expansion of free flaps is a safe and effective method to increase tissue volume for reconstruction, particularly in cases of tissue deficiency. This technique improves donor site closure and patient satisfaction, despite rare complications.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Tissue Engineering
Background:
- Tissue expansion of free flaps increases transferred tissue volume and facilitates primary donor site closure.
- This technique is crucial for patients with burns or children experiencing tissue deficiency.
Purpose of the Study:
- To evaluate the 17-year experience with tissue-expanded free flaps.
- To assess the safety, efficacy, and outcomes of pre-transfer tissue expansion in reconstructive surgery.
Main Methods:
- 14 cases of tissue-expanded free flaps performed between 1985 and 2002.
- Indications included facial defects, spinal bifida ulcers, vulvoperineal defects, and lower extremity defects.
- Flaps used: radial forearm, parascapular, and lateral arm. Expanders (250-700 mL) placed subcutaneously for 10-20 weeks.
Main Results:
- No flap failure or tissue loss occurred.
- Transient flap congestion in 3 patients resolved without intervention.
- Primary donor site closure achieved in all cases; acceptable scarring reported.
- One infection required expander removal; one hypertrophic scar needed revision.
Conclusions:
- Pre-expansion of free flaps is an effective, safe, and underused reconstructive method.
- It allows for larger tissue transfer in deficient areas and improves donor site aesthetics.
- High patient satisfaction and good long-term outcomes were observed.