THE FATE OF LOWER-EXTREMITIES WITH FAILED FREE FLAPS

This study reviews the outcome of patients with failed free flaps to l ower extremities. The failure rate was 10 percent (41 of 413 flaps) ov er a 13-year period. Trauma patients (83 percent of all patients) had a failure rate of 11 percent, while nontrauma patients had a failure r ate of 6.7 percent. The most common cause of failure was venous thromb osis (34 percent). Eight of 36 patients (22 percent) went on to amputa tion after the failed free flap; all were trauma patients. Patients wi th tibia-fibula fractures had a 35 percent amputation rate (6 of 17 pa tients) after a failed free flap. Seventy-eight percent of the patient s (28 of 36) had salvage of their extremities by split-thickness skin graft, local flaps, or a second free flap. Long-term follow-up was ava ilable in 24 of 36 patients (67 percent), 20 of whom were salvaged wit hout amputation. Of the patients whose limbs were salvaged, none had u ndergone an amputation at a mean follow-up of 6.2 years. All were ambu lating, but 7 (35 percent) had intermittent wound breakdown. Despite a n initial free-flap loss, the majority of extremities can be salvaged with subsequent procedures. However, on long-term follow-up, a large p ercentage of patients continue to have wound problems.