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Free tissue failure is not an all-or-none phenomenon
1Department of Surgery, University of Illinois at Chicago, Illinois, USA.
Plastic and Reconstructive Surgery
|September 1, 1995
Summary
Free tissue transfers can fail gradually due to microemboli, not just sudden thrombosis. Expectant management of failing free flaps can lead to successful tissue survival and coverage.
Area of Science:
- Plastic Surgery
- Microsurgery
- Vascular Surgery
Background:
- Microsurgeons often believe free tissue failure is an immediate event caused by primary thrombosis.
- This study challenges the "all-or-none" concept of free flap failure.
Observation:
- Free tissue transfers can experience slow, partial failure due to secondary thrombosis from microemboli.
- Ten patients with failing free flaps, including lower extremity reconstructions for ulcers and trauma, and reconstructions for cheek, chest wall, and thumb, were analyzed over six years.
Findings:
- Flap compromise was detected between 4 hours and 6 weeks post-surgery.
- Salvage methods included thrombectomy, anastomotic revision, and streptokinase.
- Expectant management with daily dressing changes, tangential excision, and delayed skin grafting led to successful tissue survival and coverage in all cases.
Implications:
- This study suggests a paradigm shift in understanding free flap failure.
- Expectant management may be a viable strategy for select failing free flaps, improving reconstructive outcomes.
- Further research into the mechanisms of secondary thrombosis and optimal management protocols is warranted.