VASCULAR COMPLICATIONS OF VASCULARIZED COMPOSITE TISSUE TRANSFER - OUTCOME AND SALVAGE TECHNIQUES

Two hundred fifty-two vascularized composite tissue transfers were per formed from 1985 to 1992 at Nara Medical University Hospital. Free tis sue transfers were performed in 185 patients and island tissue transfe rs in 67 patients. Of these, 39 flaps were reexplored because of vascu lar complications. On initial reexploration, vascular obstruction was found at the site of anastomosis or in the main vascular pedicle in 36 patients and in the perforating vessels to the monitor flap in three patients. Arterial thrombus occurred in 11 patients, venous thrombosis in 12, and both in nine. Twenty-five reexplored flaps were salvaged. Initially, heparin was administered systemically when vascular comprom ise was suspected intraoperatively or postoperatively. Recently, we ha ve used a ''continuous local heparinization'' technique to minimize bl ood loss. This method has been used in 12 patients who underwent reexp loration and in nine patients in whom vascular compromise was suspecte d. Nineteen flaps survived completely, and two flaps failed. (C) 1993 Wiley-Liss, Inc.