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Lower extremity free flaps: a review

M D Wells1, C V Bowen, R T Manktelow

  • 1Division of Plastic and Reconstructive Surgery, University of Kentucky Medical Center, Lexington, USA.

Canadian Journal of Surgery. Journal Canadien De Chirurgie
|June 1, 1996
PubMed
Summary
This summary is machine-generated.

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Free-flap coverage for lower extremity fractures, particularly Type IIIB tibial fractures, is associated with a higher risk of failure. Fracture grade is the primary predictor of negative outcomes in these complex reconstructive surgeries.

Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Reconstructive Surgery

Background:

  • Lower extremity fractures often present with significant soft-tissue or bony defects.
  • Free-flap transfer is a reconstructive option for severe limb injuries.
  • Identifying factors predicting free-flap success is crucial for patient outcomes.

Purpose of the Study:

  • To identify factors associated with negative outcomes in free-flap coverage of lower extremity fractures.
  • To determine predictors of free-flap failure in patients with tibial fractures.

Main Methods:

  • Retrospective chart review of patients undergoing free-tissue transfer to the lower extremity.
  • Analysis of 49 patients with tibial fractures and defects, with over 1 year of follow-up.
  • Evaluation of potential factors including injury mechanism, fracture grade, comorbidities, and intraoperative variables.

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Main Results:

  • Type IIIB tibial fractures were significantly linked to higher free-flap failure rates (p=0.02).
  • Average time from injury to flap coverage was 1006 days, with a mean of four prior procedures.
  • Successful flap coverage was achieved in 78% of patients; 74% of fractures healed, with a 10% amputation rate.

Conclusions:

  • The grade of tibial fracture is the only significant factor related to postoperative free-flap failure.
  • Effective management of complex lower extremity fractures requires careful consideration of fracture severity for reconstructive planning.