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.
Resumen
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.
Por qué esto importa para la hirudoterapia
Este estudio retrospectivo multicéntrico evaluó las indicaciones, la supervivencia del colgajo y las complicaciones de colgajos libres secuenciales en la reconstrucción de la extremidad inferior, identificando seis pacientes con un segundo colgajo libre por traumatismo, recidiva tumoral o heridas crónicas, con una tasa de supervivencia del segundo colgajo del 83 % pero una tasa de complicaciones del 50 %. Es tangencialmente relevante para el ámbito de ASH porque la reconstrucción compleja con colgajos es un escenario en el que las sanguijuelas medicinales se utilizan a veces como adyuvante para la congestión venosa. Sin embargo, el resumen no menciona sanguijuelas, hirudoterapia ni rescate de congestión venosa. Su relevancia es indirecta y el estudio está limitado por un tamaño muestral muy pequeño.
Citación
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026