Unfavourable results in free tissue transfer

Abstract

With recent advances in the instrumentation and with increased expertise the results of microvascular surgery are getting better. Complications though, cannot be completely avoided. This paper gives a brief introduction to the possible complications at various stages of free tissue transfer. With careful planning and execution and vigilant postoperative care the overall success rate can be improved.

Keywords: Free tissue transfer; re-exploration; unfavourable results.

Figure 1

(a) Ideal arrangement of vessels, they should be of similar length and preferably lie parallel to each other. If they are crossing each other one should make sure that the artery is not compressing the vein. (b) The vein crossing the artery but the lie is comfortable. (c and d) If the length of the vein and the artery are different the longer vessel tends to kink. In the figures shown the vein on either side can have this tendency if left longer than artery

Figure 2

(a) If both the vessels are long and redundant then the chances of kink are much higher. (b) Long redundant vessels even tend to get twisted around themselves decreasing the flow and increasing the chances of thrombosis. (c) If the orientation is not right especially the vein as it is low pressure system is vulnerable to pressure from the overlying artery/ or between the artery and the skin. (d) When doing two veins, again the arrangement should be made as easy as possible for primary surgery as well as possible exploration

Figure 3

Schematic representation of the placement of cannula in a vein when there is a doubt about the health of intima and there are no other options. The heparin saline given through cannula continuously irrigates the anastomosis

Figure 4

A 25-year-old girl with hydreadenitis suppurativa, with diseased and scared skin in the axilla was taken up for debridement and flap cover. (a) The defect after completion of debridement. (b) Groin flap was used for the cover. The flap was transferred to the defect. In the post-operative flap developed congestion and she had to be rushed to the OT. (c) On opening the skin sutures, there was a large hematoma that was drained. (d) Immediate exploration saved the flap and ultimately the flap settled well