Unfavourable results in free tissue transfer

Abstract

With recent advances in the instrumentation and with increased expertise the results of microvascular surgery are getting better. Complications though, cannot be completely avoided. This paper gives a brief introduction to the possible complications at various stages of free tissue transfer. With careful planning and execution and vigilant postoperative care the overall success rate can be improved.

Microsurgical reconstruction in patients greater than 80 years old

“…With the evolution of better anesthetic techniques and improved peri‐operative management, the risk of complications has been reduced distinctly (Wolters, Wolf, Stützer, & Schröder, ). Since introduction of microvascular tissue transfer in the early 1970s the gradual improvement of instruments, techniques, and experience has led to success rate currently over 95% of free flap reconstructions (Khouri et al, ; Koul, Patil, & Nahar, ). Surgical and medical care becomes far more complex as the older population frequently has chronic conditions, which in dependence of individual variety and severity may significantly influence postoperative outcomes.…”

Transdermal application of azithromycin-amlodipine-heparin gel enhances survival of infected random ischaemic flap

“…Transdermal application to skin flaps potentially increases the quantity of drug in the flap and decreases its concentration in the circulatory system, which should consequently improve drug bioavailability and reduce systemic side-effects [13]. Given that flap necrosis is usually associated with vasospasm, thrombosis, and infection [14], and impaired blood supply and infection are usually concomitant, improving flap blood circulation with antibiotic treatment should improve outcomes. The antibiotic azithromycin (AZM) has been shown to inhibit the growth of Staphylococcus aureus and Escherichia coli, the common bacterial causes of flap infection.…”

Use of Tissue Plasminogen Activator to Salvage a Precious Free Tissue Transfer

“…With meticulous pre-, intra-, and postoperative care, risk of failure can be minimized though it cannot be eliminated. 1 The venous system being a low-pressure system is prone to stasis, subsequent thrombosis, and obstruction with minimal variation in flow dynamics or external pressure. Venous compromise is commoner than arterial obstruction among the factors leading to unfavorable outcomes following free tissue transfers.…”

“…Venous compromise is commoner than arterial obstruction among the factors leading to unfavorable outcomes following free tissue transfers. 1 We are presenting a case of a free fibular osteo-cutaneous flap which was salvaged with an intra-arterial injection of recombinant tissue plasminogen activator (rtPA).…”