Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 38:
  Published accounts of microsurgical complications generally report either anecdotal or quantitative information. Anecdotal reports concentrate on intraoperative details, logistic problems (transport of amputated parts, team organization, etc.), anatomic pitfalls, and other descriptive analyses that do not lend themselves to quantitation. In this book, most anecdotal analyses of complications occur within the discussion of each specific technique. Two recently published reviews1,2 contain thorough descriptive surveys of technical and logistical complications.

Quantitative presentations have become more frequent and comprehensive with the growing clinical experiences of many groups. These analyses provide information that contributes to the establishment of recognized standards of performance, the investigation of common problems, and the documentation of the advantages and disadvantages of the expanding number of microsurgical reconstructive options. Published clinical reports offer a reasonably detailed picture of the quality of success and morbidity of free-tissue transfer, replantation, and toe-to-hand transfers.

Free-Tissue Transfer (Table 38-1)

The advantages of free-tissue transfer procedures in managing complex and infected defects include fewer operations, fewer complications, shorter hospitalizations, and greater chance of a satisfactory and functional result than reported with other methods of reconstruction.

  The results of free-tissue transfers should be judged, at least in part, in comparison with older reports of complex reconstructive problems. For example, in 1968, Harrison 3 reported a group of 52 patients with open tibial fractures managed by either cross-leg flaps, tubed pedicle flaps, local flaps, or prolonged wound care followed by skin grafting. Thirty-five percent of these patients never achieved wound coverage, and all had multiple operations. The average length of hospitalization for those cases that did result in successful closure was 10 to 12 months. Seventy-five percent of bone grafts, attempted in patients who eventually achieved soft tissue coverage, failed because of infection. The innovation of free-tissue transfer provides an option that offers more reliable and efficient management of these kinds of wounds.4-7

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