The clinical applications of microvascular free in reconstructive surgery have been expanded tremendously since their clinical introduction in 1973. Success rates are greater than 90 percent in several large series.
Difficult reconstructions can now be accomplished in a one stage procedure.
The retrospective study of the clinical experiences of one hundered consecutive free tissue transfer in recent 5 years was performed, and concluded as follows.
1. The used flaps were 29 Jejunal flaps. 21 Latissimus Dorsi flaps. 16 Forearm flaps, 7 Scapular flaps. 5 Wrap around precedures. 4 Temporal fascia flaps. 4 Vasculized n. grafts, 3 Rectus abdomis flaps, 3 Toe to finger, 2 TRAM flaps, 2 Groin
flaps, I
Iliac osteocutaneous flaps, and 1 Fibular osteocutaneous flap.
2. The 58 flaps were used for head & neck reconstruction 16 for reconstruction of upper extremity, 18 for reconstruction by lower extremity, 4 for reconstruction of trunk, and 4 for reconstruction of penis
3. There were 3 total flap necrosis and 2 partial necrosis, so the overall survival rate was 97%.
4. The emergent reexploration was performed in 5 cases out of 100 cases so that all of them were successful in survival.
5. The preferable flaps in our series according to the reconstructed area are as follows:
Head & face-Latissimus Dorsi
Forearm
Oral cavity & Esophagus -Jejunal flap
Upper extremity-Wrap around
Temporal fascia
Trunk -TRAM
Latissimus Dorsi
Penis-Forearm
Lower extremity-Scapular
Latissimus Dorsi
6. The causes of defect were: 63 cases of malignant tumor, 25 cases of trauma, 4 cases of congenital anomaly and 8 cases others.
7. There were 4 cases by below the age of 10, and 16 cases over the age of 60, But there was no difference in success rate between the different age group.
8. 10 cases out of 100 cases were anastomosed end to side especially in lower extremities, and 15 cases needed vein graft from 3cm to maximum 45cm, But there was no complication or failure due to these factors.
9. 53 cases of 100 cases were reconstructed immediately, and 47 cases were reconstructed lately. There was no difference in success rate between these groups.
10. The donor site morbidity that includes 4 cases of wound separation, 4 cases of skin graft loss, 2 cases of tendon exposure, 2 cases of wound infection and 1 case of tourniquet palsy was minimal, and significant sequeale did not happen.
11. The postoperative careful monitoring of the flap, and early detection and decision to solve the problems are most important to increase the survial rate.
|