Re-evaluating the paradigm of early free flap coverage in lower extremity trauma

Authors

  • J. Bradford Hill M.D.,

    1. School of Medicine, Vanderbilt University Medical Center, Nashville, TN
    Search for more papers by this author
  • Jeffrey E. Vogel M.D.,

    1. Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN
    Current affiliation:
    1. Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA. Gabriel A. Del Corral is currently at Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA
    Search for more papers by this author
  • Kevin W. Sexton M.D.,

    1. Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN
    Search for more papers by this author
  • Oscar D. Guillamondegui M.D., M.P.H.,

    1. Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN
    Search for more papers by this author
  • Gabriel A. Del Corral M.D.,

    1. Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN J. Bradford Hill is currently at Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
    Search for more papers by this author
  • R. Bruce Shack M.D.

    Corresponding author
    1. Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN J. Bradford Hill is currently at Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY
    • Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Medical Center North, D-4219, Nashville, TN 37232-2345
    Search for more papers by this author

Abstract

Early free flap coverage in lower extremity trauma is a practice largely supported by research that may be outdated and is frequently impractical due to logistics, resuscitation efforts, and associated injuries. Our objective was to re-evaluate this paradigm to determine whether reconstructive timing impacts outcome in modern clinical practice. We reviewed 60 free flaps for traumatic lower extremity coverage from December 2005 to December 2010 by the plastic surgery service at an academic medical center. All reconstructions were >72-hours from injury, spanning from 3 days to 2.2 years. The overall failure rate was 13.3% (8/60). Statistical analysis yielded no significant associations between reconstructive timing and flap failure or morbidity, although there was a trend toward fewer failures among latest reconstructions (>91 days) compared to within 30 days (P = 0.053). These findings support that delays may be safely utilized to allow patient and wound optimization without negatively impacting outcomes in free tissue transfer. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.

Ancillary