2
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Necrosis superficial completa de colgajo libre: una complicación inusual Translated title: Complete superficial necrosis of a free muscle flap: an unusual complication

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Resumen Aunque existe abundante literatura sobre las distintas complicaciones de los colgajos libres, la descripción de necrosis superficial completa en colgajos libres es escasa. Presentamos un caso de reconstrucción postraumática de pie con colgajo libre de músculo gracilis, que en el postoperatorio desarrolló una escara oscura y seca que cubría toda su superficie y semejaba una pérdida total del colgajo. Sin embargo, el pedículo del colgajo mantuvo en todo momento un tono activo en ecografía doppler, por lo que se decidió un manejo expectante. De manera diferida, se realizó cirugía de revisión con desbridamiento de la escara y del tejido necrótico superficial a los 21 días, descubriendo tejido sano del colgajo subyacente, que fue injertado. Posteriormente, el colgajo mostró una evolución favorable con una buena integración del injerto. Aunque en nuestro paciente no se identificó la causa exacta de esta complicación, se discuten las posibles etiologías con especial hincapié en el tabaco como factor de riesgo.

          Translated abstract

          Abstract Although an abundant body of literature exists on complications of free flaps, the description of complete superficial necrosis occurring in free flaps is scarce. Herein, we present a case of a post-traumatic foot reconstruction with a gracilis muscular free flap which postoperatively developed a thick dry black eschar covering its entire surface that suggested total flap loss. However, percutaneous doppler ultrasound of the flap pedicle maintained a lively tone, so an initial expectant management was decided. A delayed revision surgery was performed at day 21 with debridement of the eschar and superficial necrotic tissue uncovering underlying healthy flap tissue, which was skin-grafted. Subsequently, the flap showed good progress with good graft integration. Although the exact cause for this complication was not identified in our patient, possible etiologies are discussed with a focus on tobacco as a major risk factor.

          Related collections

          Most cited references12

          • Record: found
          • Abstract: found
          • Article: not found

          Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps.

          Microvascular free tissue transfer is a reliable method for reconstruction of complex surgical defects. However, there is still a small risk of flap compromise necessitating urgent reexploration. A comprehensive study examining the causes and methods of avoiding or treating these complications has not been performed. The purpose of this study was to review the authors' experience with a large number of microvascular complications over an 11-year period. This was a retrospective review of all free flaps performed from 1991 to 2002 at Memorial Sloan-Kettering Cancer Center. All patients who required emergent reexploration were identified, and the incidence of vascular complications and methods used for their management were analyzed. A total of 1193 free flaps were performed during the study period, of which 6 percent required emergent reexploration. The most common causes for reexploration were pedicle thrombosis (53 percent) and hematoma/bleeding (30 percent). The overall flap survival rate was 98.8 percent. Venous thrombosis was more common than arterial thrombosis (74 versus 26 percent) and had a higher salvage rate (71 versus 40 percent). Salvaged free flaps were reexplored more quickly than failed flaps (4 versus 9 hours after detection; p = 0.01). There was no significant difference in salvage rate in flaps requiring secondary vein grafting or thrombolysis as compared with those with anastomotic revision only. Microvascular free tissue transfer is a reliable reconstructive technique with low failure rates. Careful monitoring and urgent reexploration are critical for salvage of compromised flaps. The majority of venous thromboses can be salvaged. Arterial thromboses can be more problematic. An algorithm for flap exploration and salvage is presented.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            A prospective study of microvascular free-flap surgery and outcome.

            Over a 6-month period, 23 members of the International Microvascular Research Group participated in a prospective survey of their microvascular free-flap practice. Data were recorded with each case for 60 variables covering patient characteristics, surgical technique, pharmacologic treatment, and postoperative outcome. A total of 493 free flaps were reported with a representative demographic distribution for age, sex, indications for surgery, risk factors, flap type, surgical technique, and pharmacologic intervention. Mixed effects logistic regression modeling was used to determine predictors of flap failure and associated complications. The overall incidence of flap failure was 4.1 percent (20 of 493). Reconstruction of an irradiated recipient site and the use of a skin-grafted muscle flap were the only statistically significant predictors of flap failure, with increased odds of failure of 4.2 (p = 0.01) and 11.1 (p = 0.03), respectively. A postoperative thrombosis requiring re-exploration surgery occurred in 9.9 percent of the flaps. The incidence of this complication was significantly higher when the flap was transferred to a chronic wound and when vein grafts were needed, with increased odds of failure of 2.9 (p = 0.02) and 2.5 (p = 0.02), respectively. There was a lower incidence of postoperative thrombosis when rectus/transverse rectus abdominis muscle (TRAM) flaps were used, where odds of failure decreased by 0.36 (p = 0.04), and when subcutaneous heparin was administered in the postoperative period, where odds decreased by 0.27 (p = 0.04). There was an overall 69-percent salvage rate for flaps identified with a postoperative thrombosis. Intraoperative thrombosis occurred in 41 cases (8.3 percent) and was observed more frequently in myocutaneous flaps or when vein grafts were needed (5.5 and 5.0 greater odds, respectively; p < 0.001) but was not associated with higher flap failure (2 of 41 cases; 4.9-percent failure rate). The incidence of a hematoma and/or hemorrhage was increased in obese patients and when vein grafts were needed [2.7 (p = 0.02) and 2.6 (p = 0.03) greater odds, respectively], whereas this complication was significantly decreased in muscle flaps (myocutaneous or skin-grafted muscle), in tobacco users, when a heparinized solution was used for general wound irrigation, and when the attending surgeon performed the arterial anastomosis (in contrast to the resident or fellow on staff) (p < 0.05 for each factor). With the multivariable analysis, many factors were found not to have a significant effect on flap outcome, including the recipient site (e.g., head/neck, breast, lower limb, etc.); indications for surgery (trauma, cancer, etc.); flap transfer in extremes of age, smokers, or diabetics; arterial anastomosis with an end-to-end versus end-to-side technique; irrigation of the vessel without or with heparin added to the irrigation solution; and a wide spectrum of antithrombotic drug therapies. These results present a current baseline for free-flap surgery to which future advances and improvements in technique and practice may be compared.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Free flaps for reconstruction of soft tissue defects in lower extremity: A meta-analysis on microsurgical outcome and safety.

              Microsurgical free flaps for reconstruction of soft tissue defects in lower extremity have evolved into a reliable procedure over last decades; however, there lacked high level of evidence.
                Bookmark

                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                September 2021
                : 47
                : 3
                : 305-308
                Affiliations
                [2] Pamplona orgnameClínica Universidad de Navarra orgdiv1Departamento de Cirugía Plástica y Reconstructiva España
                [1] orgnameClínica Universidad de Navarra orgdiv1Departamento de Cirugía Plástica y Reconstructiva
                Article
                S0376-78922021000300011 S0376-7892(21)04700300011
                10.4321/s0376-78922021000300011
                d604cd95-9f4a-4d47-9c56-50a85ee5c1f8

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 06 July 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 4
                Product

                SciELO Spain

                Categories
                Reconstructiva

                Tobacco,Necrotic eschar,Free flap,Flap complication,Complete superficial necrosis,Tabaco,Escara necrótica,Colgajo libre,Complicación colgajo,Necrosis superficial completa

                Comments

                Comment on this article