The fate of lower extremities with failed free flaps

Theresa Benacquista, Armen K. Kasabian, Nolan S. Karp

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63 Scopus citations


This study reviews the outcome of patients with failed free flaps to lower extremities. The failure rate was 10 percent (41 of 413 flaps) over a 13-year period. Trauma patients (83 percent of all patients) had a failure rate of 11 percent, while nontrauma patients had a failure rate of 6.7 percent. The most common cause of failure was venous thrombosis (34 percent). Eight of 36 patients (22 percent) went on to amputation after the failed free flap; all were trauma patients. Patients with tibia-fibula fractures had a 35 percent amputation rate (6 of 17 patients) after a failed free flap. Seventy- eight percent of the patients (28 of 36) had salvage of their extremities by split-thickness skin graft, local flaps, or a second free flaps. Long-term follow-up was available in 24 of 36 patients (67 percent), 20 of whom were salvage without amputation. Of the patients whose limbs were salvaged, none had undergone an amputation at a mean follow-up of 6.2 years. All were ambulating, but 7 (35 percent) had intermittent wound breakdown. Despite an initial free-flap loss, the majority of extremities can be salvaged with subsequent procedures. However, on long-term follow-up, a large percentage of patients continue to have wound problems.

Original languageEnglish (US)
Pages (from-to)834-842
Number of pages9
JournalPlastic and reconstructive surgery
Issue number5
StatePublished - Oct 1 1996

ASJC Scopus subject areas

  • Surgery


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