[Emergency free flap in reconstruction of the lower limb: About 23 cases over 11 years]

Abstract

Objectives: To study the coverage period influence and various parameters concerning the microsurgical act on the patient clinical outcomes.

Methods: We report 23 cases of reconstruction of lower limb loss of substance by free flap operated from 2010 to 2021. Among them, 9 patients were operated on as an emergency versus 14 in the secondary or late phase of the trauma.

Results: The average age of injured patients operated on emergency was 42 years (17-68 years) and 34 years for the patients who undergo deferred surgery (17-57 years). The sex ratio (female/male) was 22% in patients operated on urgently and 7% in patients operated on later. Regarding the type of free flap, it was Serratus anterior muscle flap in 10 cases, Latissismus dorsi flap in 9 cases, ALT flap in 3 cases and Gracilis muscle flap in 1 case. There were 2 failures of vascularized free transfer (8.7%) with complete necrosis of the flap and 3 revision surgeries on venous thrombosis which finally made it possible to obtain 3 flap successes. We analyze the results (complications/osteitis) according to the time to coverage.

Conclusions: In our study, we did not find any significant difference between the groups operated in emergency and at a distance concerning the rate of infection and failure of the flaps.

Keywords: Emergency; Fracture ouverte de jambe; Free flap; Lambeau libre; Lambeau musculaire; Muscular flap; Open leg fracture; Perte de substance; Soft tissue defect; Urgence.