Partial failure of a free flap salvaged by using the surviving portion as a "bridge" flap for revascularizing a...

Partial failure of a free flap can create an unusual dilemma, as guidelines suggesting appropriate further intervention are not well defined. The increased complexity of a second free flap attempt is not necessarily contraindicated, but must be minimized if the same fate as the first is to be avoided. For the unique circumstance where the initial failed flap contained a vascular flow-through, the most distal patent vessels can then secondarily serve in an expeditious manner as the recipient vessels for the second or salvage free flap. The efficacy of this concept has been here validated after limited necrosis occurred in the distal portion of a radial forearm free flap. Following the requisite debridement, the residual flap still maintained a satisfactory arterial and venous flowthrough as a "bridge flap" that supported the attachment of a gracilis muscle free flap, and both flaps in turn preserved a sensate transtarsal amputation stump.