SALVAGE OF WOUNDS FOLLOWING FAILED TISSUE-TRANSPLANTATION

During the past 20 years, 972 microvascular transplantations have been performed for 783 patients, with an overall failure rate of 6.2 perce nt. Fifty-four of the 60 failed transplantations were available for lo ng-term follow-up and were retrospectively reviewed with respect to th e original indications for transplantation, the number, and the type o f salvage procedures performed following transplant failure. This stud y illustrates that the choice of salvage procedures performed followin g transplant failure depends on the original indications, the location , and the severity of the resultant wound. Failure following transplan tation for coverage of contour defects or unstable wounds can often be managed by non-microsurgical methods. In contrast, when the indicatio ns for transplantation included the transfer of specialized tissues fo r thumb or digit reconstruction, the restoration of motor or sensory f unction, or the coverage of a limb-threatening wound, requirements for reconstruction could be satisfied only by a second successful tissue transplant. Eighteen of the 54 cases underwent an additional transplan tation, with an 89 percent success rate.