Transposition flap and skin graft techniques for optimizing anastomosis coverage

BACKGROUND: This study explores a novel technique combining transposition flaps with Split-Thickness Skin Grafts (STSG) to enhance anastomosis site coverage in free tissue transfer surgeries, particularly in lower limb reconstructions using Thoracodorsal Artery Perforator (TDAP) free flap procedures. This method aims to alleviate tension at the anastomosis sites, a common issue affecting reconstructive surgery success. METHODS: A retrospective analysis was conducted on 20 patients who underwent TDAP free flap procedures. These cases were chosen due to the anticipated tension at anastomosis sites, necessitating the use of transposition flaps and STSG. Surgical procedures were meticulously documented, and postoperative outcomes were monitored, focusing on complications and overall surgical success. RESULTS: The study found no instances of complete flap failure, indicating the potential efficacy of the combined approach. Minor complications included two cases of partial tip necrosis in the transposition flaps and two cases of partial graft loss in the STSGs. These issues were resolved through secondary intention healing, demonstrating the technique's ability to manage minor postoperative challenges and maintain flap viability. CONCLUSION: Integrating transposition flaps with STSG significantly improves tension management at anastomosis sites in TDAP free flap procedures. This technique not only reduces immediate postoperative complications but also supports the long-term success of reconstructive surgeries. The findings advocate for further research to confirm the efficacy of this approach in microsurgical applications, aiming to enhance patient outcomes and advance reconstructive microsurgery.

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In 20 patients undergoing thoracodorsal artery perforator free flap procedures for lower limb reconstruction, combining transposition flaps with split-thickness skin grafts reduced anastomotic tension; minor complications included two cases each of partial flap tip necrosis and partial graft loss.

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