J Reconstr Microsurg 2014; 30(06): 427-430
DOI: 10.1055/s-0034-1371510
Original Article WSRM 2013 Scientific Paper
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Traumatic Lower Limb Injury and Microsurgical Free Flap Reconstruction with the Use of Negative Pressure Wound Therapy: Is Timing Crucial?

Ashvin Raju
1  Yong Loo Lin School of Medicine, National University of Singapore, Singapore
,
Adrian Ooi
2  Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Yee Siang Ong
2  Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Bien Keem Tan
2  Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
› Author Affiliations
Further Information

Publication History

03 November 2013

31 December 2013

Publication Date:
21 April 2014 (online)

Abstract

Background The timing of microsurgical free flap reconstruction for traumatic lower limb injury has been described as being optimal if conducted within the early period following injury, as higher rates of infection and flap loss were reported in the subsequent time period. However, for various reasons, reconstruction of these defects may be delayed. The aim of this article is to show that adequate debridement, negative pressure wound dressing, and sound reconstructive principles has led to increased free flap success rates regardless of the period between injury and reconstruction.

Patients and Methods A 10-year retrospective single-center analysis of 50 traumatic lower limb cases from 2002 to 2012 was conducted. All patients had microsurgical free flap reconstruction after a period of negative pressure wound therapy (NPWT). Patient factors and reconstructive methods were analyzed and outcomes were compared.

Results Mean interval between admission and free flap coverage was 17.5 days, and patients underwent NPWT for an average of 12 days (range, 1–35). Approximately 8% of patients had postoperative infections. Overall free flap success rate was 96%. Approximately 90% of patients were able to return to their premorbid footwear, with 96% able to mobilize independently approaching the end of their follow-up period.

Conclusion Our study shows that traumatic lower limb reconstruction in the delayed period is no longer associated with high rates of flap failure. Improvements in microsurgery and the advent of NPWT have made timing no longer crucial in free flap coverage of traumatic lower limb injuries.