Long-term results following free tissue transfer for venous stasis ulcers

Venous stasis ulcers of the lower extremity are a common problem usually treated successfully with conservative measures or skin grafting. However, for a minority of wounds that are refractory to standard therapy, microsurgical flap reconstruction has been used to introduce new tissue with its own healthy microvenous system. This retrospective study analyzes the long-term outcome of venous ulcers treated with free tissue transfer. Between 1983 and 1993, 14 free flap reconstructions of chronic leg wounds were performed (mean follow-up, 5.4 years). A complication rate of 43% occurred in the postoperative period, with two complete flap failures. Development of new ulcers was noted in all patients by an average of 17.2 months. In all patients the ulcers developed in previously intact skin, usually at the margin of the flap, but in some instances they developed distant to the original area of involvement. It is inferred that the ongoing effects of venous hypertension in the leg lead to ulcer recurrence, and therefore the widest possible resection of all chronically inflamed tissue around the ulcer is recommended. This report suggests that microsurgical flap reconstruction is a palliative measure for venous stasis ulcers, rather than a permanent solution. However, even with recurrent ulceration, many of the patients appeared to have had some symptomatic improvement from the use of free flaps.