Struebing Felix, Xiong Lingyun, Bigdeli Amir K, Diehm Yannick, Kneser Ulrich, Hirche Christoph, Gazyakan Emre
Department of Hand-, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, Heidelberg University, 67071 Ludwigshafen, Germany.
Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
J Pers Med. 2022 Sep 22;12(10):1563. doi: 10.3390/jpm12101563.
There is no clear consensus on the optimal surgical strategy for providing safe coverage in salvage free flap surgery after total free flap failure. A retrospective study was conducted to evaluate patients with total failure of the primary free flap in lower extremity reconstruction between 2000 and 2017. In a cohort of 1.016 patients, we identified 43 cases of total flap failure (4.2%). A total of 30 patients received a salvage free flap with a success rate of 83.3% (25/30). One patient received a secondary salvage free flap. Overall limb salvage after primary free flap loss was 83.7% (36/43). Microsurgical management of free flap loss in the lower extremity is challenging and requires a decisive re-evaluation of risk factors and alternative strategies. This should include reconsidering the flap choice with a tendency towards traditional and safe workhorse flaps, a low-threshold switch to different recipient vessels, including arteriovenous (AV) loops, bypasses (especially in case of venous insufficiency) and back-up procedures, such as negative pressure wound therapy or dermal regeneration templates with skin grafting in cases of lower demand and critically ill patients. We derived one suggestion from our previous practice: replacing perforator flaps with axial pattern flaps ("safe workhorses").
对于在游离皮瓣完全失败后进行挽救性游离皮瓣手术以提供安全覆盖的最佳手术策略，目前尚无明确的共识。我们进行了一项回顾性研究，以评估2000年至2017年间在下肢重建中初次游离皮瓣完全失败的患者。在一组1016例患者中，我们确定了43例皮瓣完全失败的病例（4.2%）。共有30例患者接受了挽救性游离皮瓣，成功率为83.3%（25/30）。1例患者接受了二次挽救性游离皮瓣。初次游离皮瓣丢失后的总体肢体挽救率为83.7%（36/43）。下肢游离皮瓣丢失的显微外科处理具有挑战性，需要对危险因素和替代策略进行果断的重新评估。这应包括重新考虑皮瓣选择，倾向于选择传统且安全的常用皮瓣，低门槛地转换到不同的受区血管，包括动静脉（AV）袢、旁路（特别是在静脉功能不全的情况下）以及备用程序，如在需求较低和病情危重的患者中采用负压伤口治疗或带皮肤移植的真皮再生模板。我们从以往的实践中得出一条建议：用轴型皮瓣（“安全的常用皮瓣”）替代穿支皮瓣。
