Factors associated with failure of free gracilis flap in reconstruction of acute traumatic leg defects

Abstract

Background: Possible factors associated with failure of free gracilis flaps were studied. Materials and methods: All gracilis free flaps used to reconstruct acute traumatic leg defects in a 5 year period were collected. This included open fractures of the tibia and/or fibula in which a gracilis free flap was used for reconstruction. Pre-op factors included age, ethnicity, gender, presence of diabetes, ischaemic heart disease, peripheral vascular disease, or coagulation disorders; days from trauma to flap surgery, Gustilo class, presence of a concurrent ipsilateral femur fracture, and use of CT angiogram to determine adequacy of blood supply. Intra-op factors included type of arterial anastomosis (end to side or end to end), presence of arterial transection, initial arterial anastomotic failure, initial venous anastomotic failure, use of systemic vasoconstrictors by anaesthetists for correction of hypotension, and use of modulators of the coagulation mechanism (dextran/heparin). Post-op factors included post-op day when flap was removed and use of modulators of the coagulation mechanism. Results: Patients with a concurrent ipsilateral femur fracture had a 9.67 (95% CI of OR = 1.32–70.96) times increased risk of flap failure compared to patients without an associated femur fracture. Conclusion: The finding of increased risk of free gracilis flap failure for coverage of leg defects in patients with ipsilateral femur fractures has implications on flap selection and pre-operative counselling. In such a situation, a non-microvascular option could be safer if it is available as an alternative.

Keywords:

• complications
• free flaps
• microsurgery
• open fracture

Acknowledgement

Presented at the Inaugural Congress of Asian Pacific Federation of Societies for Reconstructive Microsurgery. 8–9 October 2012, Singapore.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.