LONG-TERM RESULTS FOLLOWING FREE TISSUE TRANSFER FOR VENOUS STASIS ULCERS

Venous stasis ulcers of the lower extremity are a common problem usual ly treated successfully with conservative measures or skin grafting. H owever, for a minority of wounds that are refractory to standard thera py, microsurgical flap reconstruction has been used to introduce new t issue with its own healthy microvenous system. This retrospective stud y analyzes the long-term outcome of venous ulcers treated with free ti ssue transfer. Between 1983 and 1993, 14 free flap reconstructions of chronic leg wounds were performed (mean follow-up, 5.4 years). A compl ication rate of 43% occurred in the postoperative period, with two com plete flap failures. Development of new ulcers was noted in all patien ts by an average of 17.2 months. In all patients the ulcers developed in previously intact skin, usually at the margin of the flap, but in s ome instances they developed distant to the original area of involveme nt. It is inferred that the ongoing effects of venous hypertension in the leg lead to ulcer recurrence, and therefore the widest possible re section of all chronically inflamed tissue around the ulcer is recomme nded. This report suggests that microsurgical flap reconstruction is a palliative measure for venous stasis ulcers, rather than a permanent solution. However, even with recurrent ulceration, many of the patient s appeared to have had some symptomatic improvement from the use of fr ee flaps.