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Updated: May 13, 2025

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Sequential Free Flaps in Lower Extremity Reconstruction.

Dun-Wei Huang1,2, Floris V Raasveld1,3,4, Omar Moussa1,5

  • 1Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

JPRAS Open
|April 16, 2025
PubMed
Summary

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This summary is machine-generated.

Sequential free flaps are a viable option for complex lower extremity (LE) reconstruction, offering limb salvage despite an 83% survival rate and a 50% complication rate. Careful planning with vascular imaging is recommended.

Area of Science:

  • Reconstructive Surgery
  • Microsurgery
  • Limb Salvage Surgery

Background:

  • Sequential free flaps are standard for head and neck reconstruction but less common for lower extremity (LE) defects.
  • This study investigates their use in LE reconstruction after trauma, oncology, or chronic infection.

Purpose of the Study:

  • To evaluate the indications, flap survival rates, and complications of sequential free flaps in lower extremity reconstruction.

Main Methods:

  • Retrospective analysis of a multicenter database (2002-2020) of adult patients undergoing sequential free flaps for LE reconstruction.
  • Outcome measures included flap viability and associated complications.

Main Results:

  • Six patients underwent sequential free flaps for trauma (33%), tumor recurrence (17%), or chronic infection (50%).
Keywords:
ComplicationsLower extremityRevision surgerySequential free flap

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  • Most second free flaps survived (83%), though one patient required amputation.
  • Complications occurred in 50% of cases.

    • Conclusions:

    • Failure of durable wound closure, not flap loss, is a key indication for secondary LE free flap reconstruction.
    • Preoperative vascular imaging and distinct recipient vessels are advised.
    • Sequential free flaps can achieve limb salvage but carry significant complication risks.