Arch Hand Microsurg.  2018 Jun;23(2):121-125. 10.12790/ahm.2018.23.2.121.

An Iatrogenic Flap Necrosis Case: Factors to Consider for Successful Flap Elevation

• Ha NH
• Lee IJ

• KMID: 2412482
• DOI: http://doi.org/10.12790/ahm.2018.23.2.121

Abstract

The free flap technique has been used for lower limb reconstruction. Still, the free flap itself and related surgical procedures are challenging process, because there's a lot of factors to consider for successful outcome. We report a case of total flap necrosis due to inadequate flap elevation on the left ankle of a young man. Although the shape of the elevated flap was not fit into rectangular shape exactly, the length to width ratio of the flap was almost 2.25:1. The circulation to the tissue was not enough to flap survival, due to inadequate incision. To prevent flap mismanagement, all the surgical procedure should be performed based on a thorough understanding of flap related knowledge, such as length-width ratio restriction of elevated flap, angiosome and proper surgical incision. Also we recommend swell-timed consultation with surgeons trained in microsurgery for guidance regarding flap evaluation and its subsequent management.

Keyword

Free flaps; Microsurgery; Lower extremity; Angiosome

MeSH Terms

Ankle
Free Tissue Flaps
Lower Extremity
Microsurgery
Necrosis*
Surgeons

Figure

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  Fig. 1 Total flap necrosis of a thoracodorsal artery perforator free flap at 1 year after surgery. Necrosis was due to inadequate U-shaped flap elevation.

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  Fig. 2 Angiography of the patient's lower extremity. The anterior tibial artery supplies the flap. The posterior tibial artery is intact. Well-developed collateral arteries are present.

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  Fig. 3 Postoperative clinical photograph after removing all stitches.

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  Fig. 4 Photograph of the patient at 3.5 months after surgery reveals no complications.

Reference

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