Free Tissue Transfer in Treatment of the Recalcitrant Chronic Venous Ulcer
| Autor: | James J. Schuler, Norman Weinzweig |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Reoperation Microsurgery medicine.medical_specialty Adolescent medicine.medical_treatment Free flap Anastomosis Surgical Flaps Varicose Ulcer Veins medicine Humans Treatment Failure Vein Aged Leg Wound Healing business.industry Microcirculation Anastomosis Surgical Middle Aged Surgery Plastic surgery medicine.anatomical_structure Skin grafting Female business Varices Follow-Up Studies |
| Zdroj: | Annals of Plastic Surgery. 38:611-619 |
| ISSN: | 0148-7043 |
| DOI: | 10.1097/00000637-199706000-00008 |
| Popis: | We propose that a long-term cure for the recalcitrant chronic venous ulcer must involve a dual surgical approach including (1) wide excision of the ulcer and surrounding liposclerotic tissue bed, and (2) replacement by a free flap containing multiple, competent microvenous valves with a normal microcirculation. Advantages of free flaps over skin grafting include improvement of the underlying pathophysiology; increase in blood supply to the area; ability to cover exposed bone, joint, or tendon; and a lower incidence of recurrence. During the past 8 years, 20 consecutive muscle free flaps were performed in 18 patients for 19 recalcitrant venous ulcers (two "sequential" flaps to the ipsilateral leg in 1 patient and a repeat flap after initial failure in 1 patient). Twelve males and 6 females ranged in age from 17 to 76 years (mean, 44 years). Nontraumatic, nonosteomyelitic venous ulcers had been present for an average of 3.5 years (range, 1-10 years) and failed an average of 2.4 skin grafts (range, 0-6 grafts). Defects ranged from 100 to 600 cm2 (mean, 238 cm2). Donor tissues included rectus abdominis (N = 13), latissimus dorsi (N = 5), gracilis (N = 1), and serratus (N = 1) muscles. Recipient vessels included posterior tibial (N = 12), anterior tibial (N = 6), and peroneal (N = 2). In all instances except one, only one vein, usually one of the venae comitantes, was anastomosed in end-to-end fashion. Successful free tissue transfer was accomplished in 18 of 20 flaps (90%). Complications included infection with partial flap and/or skin graft loss (three flaps), and partial skin graft loss (two flaps). There were no recurrences within the flaps; however, breakdown occurred at the junction between the flap and residual adjacent liposclerotic skin in 1 patient. Follow-up average 32.7 months (range, 8-65 months); 3 patients were lost to follow-up. Free muscle transfer can provide a long-term cure for the recalcitrant venous ulcer by replacing the diseased tissue bed with healthy tissue containing multiple, competent microvenous valves and a normal microcirculation. This can be accomplished in one reconstructive procedure with excellent long-term results. |
| Databáze: | OpenAIRE |
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