Sequential Free Flaps in Lower Extremity Reconstruction.
Research article published in JPRAS open (2025)
Abstract
INTRODUCTION: Sequential free flaps are often utilized for complex defects, particularly for recurrent head and neck tumors. However, their application in lower extremity (LE) reconstruction following trauma or oncology is less common. This study evaluated the indications, flap survival rates, and complications of sequential free flaps utilized in LE reconstruction. METHODS: Data from our multicenter database spanning from 2002 to 2020 were analyzed retrospectively through chart review. Adult patients who underwent sequential free flaps to the LE without complete initial flap loss were included. Outcome measures included ultimate flap viability and complications associated with sequential reconstructions. RESULTS: A total of 6 patients were identified: 2 patients (33%) required a second reconstruction following trauma, 1 patient (17%) following tumor recurrence, and 3 patients (50%) for chronic wounds related to infection. Most second free flaps survived (83%), with the exception of one in which the patient ultimately underwent a transfemoral amputation. Complications were observed in 3 patients (50%). CONCLUSION: The main indication for second free flap reconstruction in the LE is the failure of durable wound closure with the first reconstruction, despite the absence of flap loss. In these complex scenarios, it is often prudent to utilize preoperative vascular imaging and to use distinct recipient vessels from those used in the first flap. Overall, sequential free flaps can be used in complex cases of limb salvage; however, they are associated with a substantial risk of complications. LEVEL OF EVIDENCE: Therapeutic-IV.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Sequential free flaps are often utilized for complex defects, particularly for recurrent head and neck tumors. However, their application in lower extremity (LE) reconstruction following trauma or oncology is less common.
Why This Matters for Hirudotherapy
This retrospective multicenter study evaluated indications, flap survival, and complications of sequential free flaps in lower extremity reconstruction, identifying six patients with second free flaps for trauma, tumor recurrence, or chronic wounds, finding an 83% second-flap survival rate but a 50% complication rate. It is tangentially relevant to ASH's domain because complex flap reconstruction is a setting where medicinal leeches are sometimes used adjunctively for venous congestion. However, the abstract makes no mention of leeches, hirudotherapy, or venous congestion salvage. Its relevance is indirect and the study is limited by very small sample size.
Citation
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