Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases

Gupta, Amit; Lakhiani, Chrisovalantis; Lim, Beng Hai; Aho, Johnathon M.; Goodwin, Adam; Tregaskiss, Ashley; Lee, Michael; Scheker, Luis R.; Saint‐Cyr, Michel

doi:10.1016/j.bjps.2015.05.009

Cited by 40 publications

(38 citation statements)

References 39 publications

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“…Trauma was the most common etiology, followed by skin ulcers and inflammation and then tumors ( Table 1 ). Flap necrosis > 60% was regarded as complete necrosis (CN), and flap necrosis ≤ 60% was regarded as partial necrosis (PN) [21]. According to Godina’s study [22], the time window from trauma to 72 hours after the trauma was considered as the acute period, while the time window of the subacute stage was between 72 hours and 90 days after the trauma.…”

Section: Methodsmentioning

confidence: 99%

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Cui

Maharjan

et al. 2016

PLoS ONE

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ObjectiveThe purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle.MethodsThis was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate. The relationship between postoperative wound infection and risk factors was also analyzed using a logistic regression model.ResultsThe overall flap survival rate was 85.42%. The necrosis rates of free flaps and pedicled flaps were 5.26% and 20.69%, respectively. According to the Cox regression model, flap type (hazard ratio [HR] = 2.592; 95% confidence interval [CI] (1.606, 4.184); P < 0.001) and postoperative wound infection (HR = 0.266; 95% CI (0.134, 0.529); P < 0.001) were found to be statistically significant risk factors associated with flap necrosis. Based on the logistic regression model, preoperative wound bed inflammation (odds ratio [OR] = 11.371,95% CI (3.117, 41.478), P < 0.001) was a statistically significant risk factor for postoperative wound infection.ConclusionFlap type and postoperative wound infection were both independent risk factors influencing the flap survival rate in the foot and ankle. However, postoperative wound infection was a risk factor for the pedicled flap but not for the free flap. Microvascular anastomosis is a major cause of free flap necrosis. To reconstruct complex or wide soft tissue defects of the foot or ankle, free flaps are safer and more reliable than pedicled flaps and should thus be the primary choice.

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Section: Methodsmentioning

confidence: 99%

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Cui

Maharjan

et al. 2016

PLoS ONE

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“…When comparing complication rates for propeller flaps in lower extremities, our findings show lower rates than the results reported by Bekara et al ., who concluded that the rate of complications was 25.2%, including PN (10.2%) and CN (3.5%) . Nevertheless, the necrotic rate for pedicled flaps was much greater than that for free flaps, and the necrotic rate for free flaps was 2.03–9.9% …”

Section: Discussionmentioning

confidence: 99%

“…According to the aforementioned criteria, 163 patients underwent 163 pedicled flap procedures at the First Hospital of Jilin University from October 2007 to March 2015. Flap necrosis >60% was regarded as complete necrosis (CN), and flap necrosis ≤60% was regarded as partial necrosis (PN) . Preoperative wound bed contamination and postoperative wound infection were identified via bacterial cultivation.…”

Section: Methodsmentioning

confidence: 99%

“…However, partial or total flap necrosis remains the main complication and has a relatively high incidence . Most studies regarding risk factors of flap necrosis have focused on the risk factors of pedicled flaps of the lower extremities and free flaps . Gir et al .…”

Section: Introductionmentioning

confidence: 99%

“…Sanati‐Mehrizy et al concluded that smoking and operative time were risk factors for free flap necrosis . In addition, previous studies have demonstrated that the rotary arc (<180°) of a pedicled flap and the timing of reconstruction of soft tissue defects have no significant effect on perioperative complications . To date, few studies have reported the total necrotic rate of various pedicled flaps and the risk factors for flap necrosis in hand soft tissue defect reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis

Gong

Cui

Jiang

et al. 2017

ANZ Journal of Surgery

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USE of arterialized saphenous vein venous flow‐through flaps as a temporizing measure for hand salvage in contaminated wounds presenting with limb ischemia: A case series

Diaz-Abele

Safa²,

Buntic³

et al. 2017

Microsurgery

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The two-stage reconstruction presented may help reconstructive and vascular surgeons consider alternatives to traditional vascular reconstruction methods. This technique avoids an exposed vascular graft in an extensively contaminated open wound. It allows the surgeon to perform thorough and sufficient debridement of the wound, preventing definitive reconstruction in a not yet declared zone of injury.

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Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases

Cited by 40 publications

References 39 publications

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis

USE of arterialized saphenous vein venous flow‐through flaps as a temporizing measure for hand salvage in contaminated wounds presenting with limb ischemia: A case series

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