THE MANAGEMENT OF UNSALVAGEABLE FREE FLAPS

The loss of vascular flow in the early postoperative period will gener ally lead to free nap failure. When attempts at flap salvage are unsuc cessful, conservative management with delayed flap debridement may be indicated. Seven unsalvageable free flaps were managed with observatio n and flap debridement 4 to 14 days following loss of vascular signals . At the time of debridement, six of the seven wounds had viable granu lation tissue and were successfully closed with skin grafts. The seven th patient had loss of vascular flow to the free nap within 12 hr of s urgery and, at the time of delayed debridement, had no evidence of gra nulation ingrowth. Local revascularization of flaps is known to occur and offers an explanation for these findings. Delayed debridement of u nsalvageable free flaps is indicated for noncritical wounds, and may o bviate the need for a second free-tissue transfer to obtain wound clos ure.