Timing of Microsurgical Reconstruction of Lower Extremity: Is It Really Important in Flap Failure?

Geliş Tarihi : 09.06.2009 Kabul Tarihi : 17.12.2009 introDuction Treatment of complicated fractures and soft tissue defects of the lower extremity depends on many factors such as the energy of the trauma, the anatomic location and the morphology of the wound, concomitant injuries and diseases and the age of the patient. With rapid advances and increased success rates, microvascular surgery became a preferred method in clinical practice. As there is a wide variety of cosmetic and functional alternatives, the traditional treatment strategies changed especially in lower extremity reconstruction.1,2 The major advantages of microvascular surgery are single stage operation, minor donor site morbidity, numerous donor flap alternatives, early mobilization and reconstruction with tissue with well circulation.1 Besides the advances in microvascular technique and operation instruments, there are still flap failures and there has not been accepted procedures to prevent flap failure.1,2 abstract Landmine injuries of the lower extremity constitute a challenging problem to the reconstructive surgeon. These injuries create composite tissue defects which are always contaminated. The transfer of the patient to a well established center generally takes time. All these factors yield a delay at the definitive treatment of the patient. Here, we want to present 109 patients injured by landmine explosions and treated at different times and discuss the effect of timing of the microvascular tissue transfer on success of the procedure. All patients were injured due to landmine explosion and reconstructed with microvascular tissue transfer. The flap success rate and postoperative complications were evaluated. The average follow-up period was 19 months. Of the 109 patients 12 were operated between 0-7 days (at the acute period). Forty-two of them were operated at the subacute period (between 7-14 days) and the remaining 55 were operated at the chronic period (more than 14 days). There was no flap loss at the patients whom were operated between 0-7 days. Flap failure rate was 16.7 % and 14.5 % for the subacute and chronic periods respectively and the difference was not significant. No postoperative infection was observed at the acute period. Postoperative infection rate was 16.7 % and 7.3 % at subacute and chronic period respectively, and the difference was statistically significant. When the surgery is performed according to microvascular principles subacute period does not differs from chronic period when the flap failure is concerned. Subacute period is associated with a higher infection rate.